Healthcare Provider Details

I. General information

NPI: 1689579922
Provider Name (Legal Business Name): SCOTT D JOLLY, DDS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8116 CANTRELL RD STE C
LITTLE ROCK AR
72227-2502
US

IV. Provider business mailing address

8116 CANTRELL RD STE C
LITTLE ROCK AR
72227-2502
US

V. Phone/Fax

Practice location:
  • Phone: 501-227-5200
  • Fax: 501-737-2046
Mailing address:
  • Phone: 501-227-5200
  • Fax: 501-737-2046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. SCOTT DOUGLAS JOLLY
Title or Position: OWNER
Credential: DDS
Phone: 501-607-4068