Provider Demographics
NPI:1063203131
Name:CONNOLLY, NOAH TIMOTHY (DMD)
Entity type:Individual
Prefix:
First Name:NOAH
Middle Name:TIMOTHY
Last Name:CONNOLLY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 HIGHWAY 44 E STE 2
Mailing Address - Street 2:
Mailing Address - City:SHEPHERDSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40165-6081
Mailing Address - Country:US
Mailing Address - Phone:502-543-3054
Mailing Address - Fax:
Practice Address - Street 1:181 HIGHWAY 44 E STE 2
Practice Address - Street 2:
Practice Address - City:SHEPHERDSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40165-6081
Practice Address - Country:US
Practice Address - Phone:502-543-3054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-16
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY11330122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist