Healthcare Provider Details

I. General information

NPI: 1285362715
Provider Name (Legal Business Name): DR. TYLER H. JOLLEY, DMD PC DOING BUSINESS AS JOLLEY SMILES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2022
Last Update Date: 08/11/2022
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

757 N MAIN ST
MOAB UT
84532-2132
US

IV. Provider business mailing address

601 28 1/4 RD UNIT E
GRAND JUNCTION CO
81506-6022
US

V. Phone/Fax

Practice location:
  • Phone: 970-523-6333
  • Fax: 970-243-3008
Mailing address:
  • Phone: 970-523-6333
  • Fax: 970-243-3008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: TONJA CRONKHITE
Title or Position: INSURANCE COORDINATOR
Credential:
Phone: 970-523-6333