Individual provider Active NPI

Mark Allen Connolly, D.D.S.

  • Dentist
  • Murfreesboro, TN
National Provider Identifier
1730361015
Registry record updated Jul 30, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
8779 Issued in TN
Practice address
2395 New Salem Hwy
Suite L
Murfreesboro, TN 37128-5256
Phone
(615) 907-3456
Fax
(615) 907-3848
NPI assigned
Nov 29, 2007
Last updated
Jul 30, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 8779 TN Primary

Addresses

Primary practice location

2395 New Salem Hwy
Suite L
Murfreesboro, TN 37128-5256

Mailing address

2395 New Salem Hwy Ste L
Murfreesboro, TN 37128-5256
Phone (615) 907-3456

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
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

Enrollment IDStateProvider typePAC IDDetails
I20160629001608 TN Order and Referring Only - DentistPractitioner - Dentist 9830480417

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
8779TNMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Sie Investment Group LLC Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1196294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1785369600000",
    "number": "1730361015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2395 NEW SALEM HWY STE L",
            "city": "MURFREESBORO",
            "state": "TN",
            "postal_code": "371285256",
            "telephone_number": "615-907-3456",
            "fax_number": "615-907-3848"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2395 NEW SALEM HWY",
            "address_2": "SUITE L",
            "city": "MURFREESBORO",
            "state": "TN",
            "postal_code": "371285256",
            "telephone_number": "615-907-3456",
            "fax_number": "615-907-3848"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONNOLLY",
        "first_name": "MARK",
        "middle_name": "ALLEN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-11-29",
        "last_updated": "2026-07-30",
        "certification_date": "2026-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TN",
            "license": "8779",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Murfreesboro, TN

Sources for this page

Verify at the official NPI Registry.