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Individual

JENNIFER R CONNOLLY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
RDH

Contact information

Practice address
4536 22ND AVE, KENOSHA, WI 53140-5917
(262) 656-0044
(262) 653-2218
Mailing address
11115 79TH ST, KENOSHA, WI 53158-1122
(262) 945-7316

Taxonomy

Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
6549-016
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
33805100
WI
Enumeration date
11/21/2006
Last updated
07/09/2007
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