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General NPI Number Information
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NPI Number | 1003088469
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Entity Type | Organization
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Legal Business Name | JOLY JACOB, D.M.D., P.C.
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Dates
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Enumeration Date | 03/26/2008
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Last Update Date | 03/26/2008
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Provider Practice Location Address
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Address Line | 443 W GIRARD AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19123-1454
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Country | US
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Telephone | 215-763-7985
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Fax | 215-763-7987
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Provider Business Mailing Address
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Address Line | 443 W GIRARD AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19123-1454
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Country | US
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Telephone | 215-763-7985
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Fax | 215-763-7987
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Authorized Official
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Title or Position | OWNER / PRESIDENT
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Name | DR. JOLY JACOB
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Credential | D.M.D.
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Telephone | 215-763-7985
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DS030002L
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License Number State | PA
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