Thomas William Connolly, DMD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

0160000786 Issued in VT

Practice address

118 Tilley Drive
Suite 102
South Burlington, VT 05403-7282

Phone

(802) 862-9196

Fax

(802) 862-5769

NPI assigned

Jul 28, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• University of Vermont Medical Center Inc

  dba Uvm Medical Center

  • Internal Medicine Physician
  • Burlington, VT
  • NPI 1659309615
  NPD

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

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1192579200000",
    "number": "1750395166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "118 TILLEY DRIVE",
            "address_2": "SUITE 102",
            "city": "SOUTH BURLINGTON",
            "state": "VT",
            "postal_code": "054037282",
            "telephone_number": "802-862-9196",
            "fax_number": "802-862-5769"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "118 TILLEY DRIVE",
            "address_2": "SUITE 102",
            "city": "SOUTH BURLINGTON",
            "state": "VT",
            "postal_code": "054037282",
            "telephone_number": "802-862-9196",
            "fax_number": "802-862-5769"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONNOLLY",
        "first_name": "THOMAS",
        "middle_name": "WILLIAM",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-28",
        "last_updated": "2007-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "VT",
            "license": "0160000786",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "2412",
            "state": "VT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2412",
            "state": "VT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MVP",
            "identifier": "97V003",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Concentra Health Services, Inc.
• Brittany Clarissa Conlon
• Connective Physical Therapy LLC (Connective PT Neuro Pelvic Wellness)
• Alessandra Keely Conner, OD
• Thomas B Connolly, DDS
• Jane G Conolly, MD
• Tammie Anne Consejo, LCMHC
• Clare Stokes Cook, RN, CDCES
• Kathy P Cook, M.D.
• Tiffany Cook

• Oral and Maxillofacial Surgery (Dentist) in South Burlington, VT
• Providers in South Burlington, VT by specialty
• Oral and Maxillofacial Surgery (Dentist) in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.