Jeffrey D. Connolly, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

375457 Issued in UT

Practice address

1963 E 2700 S
Salt Lake City, UT 84106-4053

Phone

(801) 467-4747

NPI assigned

Nov 15, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in UT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1700959186",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1963 E 2700 S",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841064053",
            "telephone_number": "801-467-4747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1963 E 2700 S",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841064053",
            "telephone_number": "801-467-4747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONNOLLY",
        "first_name": "JEFFREY",
        "middle_name": "D.",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "UT",
            "license": "375457",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "519545169007",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michelle Connelly, SSW
• Lacey Renee Conner
• Susan M. Conner, CPNP
• Thomas K. Conner, MD
• Dean B. Connolly, DDS
• Kaitlin Diane Connolly, APRN
• Nona A Connolly, RN
• Kathryn E Connor, PT
• Rafe C Connors, MD
• Alexis Cononelos, SSW

• General Practice Dentistry in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• General Practice Dentistry in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.