Provider Demographics
NPI:1487468393
Name:CONNOLLY, WANDY (DMD)
Entity type:Individual
Prefix:DR
First Name:WANDY
Middle Name:
Last Name:CONNOLLY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 ROLLING DR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TX
Mailing Address - Zip Code:75751-2944
Mailing Address - Country:US
Mailing Address - Phone:903-681-7730
Mailing Address - Fax:
Practice Address - Street 1:902 ROLLING DR
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TX
Practice Address - Zip Code:75751-2944
Practice Address - Country:US
Practice Address - Phone:903-681-7730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program