MEDICARE: DR. CHRIS MATTHEW JOLLEY DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	145821	UT

General Provider Information

NPI Number	:	1134168495
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRIS MATTHEW JOLLEY DDS

Provider Business Mailing Address
First Line	:	PO BOX 130
Second Line	:
City	:	MONTEZUMA CREEK
State	:	UT
Zip	:	84534-0130
Country	:	US
Telephone Number	:	435-651-3700
Fax Number	:	435-678-0608

Provider Business Practice Location Address
First Line	:	30 W MEDICAL DR
Second Line	:
City	:	MONUMENT VALLEY
State	:	UT
Zip	:	84536-7705
Country	:	US
Telephone Number	:	435-727-3000
Fax Number	:	435-727-3001

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2006
Last Update Date	:	03/07/2022

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