Individual
MICHAEL CONNOLLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1001 ILLINI DR, EAST PEORIA, IL 61611-1883
(309) 694-2620
Mailing address
1001 ILLINI DR, EAST PEORIA, IL 61611-1883
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019-025916
IL
Other
Enumeration date
11/18/2011
Last updated
11/18/2011
About Stedi
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