Healthcare Provider Details

I. General information

NPI: 1184680324
Provider Name (Legal Business Name): ROBERT L JOLLY JR. DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 JFK BLVD
NORTH LITTLE ROCK AR
72116-9217
US

IV. Provider business mailing address

3001 JFK BLVD
NORTH LITTLE ROCK AR
72116-9217
US

V. Phone/Fax

Practice location:
  • Phone: 501-758-3095
  • Fax: 501-753-5307
Mailing address:
  • Phone: 501-758-3095
  • Fax: 501-753-5307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number3209
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number56
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number3209
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: