Individual
THOMAS WILLIAM CONNOLLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
118 TILLEY DRIVE, SUITE 102, SOUTH BURLINGTON, VT 05403-7282
(802) 862-9196
(802) 862-5769
Mailing address
118 TILLEY DRIVE, SUITE 102, SOUTH BURLINGTON, VT 05403-7282
(802) 862-9196
(802) 862-5769
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
0160000786
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2412
BLUE CROSS
VT
05
—
2412
—
VT
01
—
97V003
MVP
VT
Enumeration date
07/28/2006
Last updated
10/17/2007
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