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General NPI Number Information
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NPI Number | 1457637522
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Entity Type | Organization
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Legal Business Name | JAMES M. JOLLY, JR., D.M.D, PSC
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Dates
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Enumeration Date | 11/02/2011
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Last Update Date | 11/02/2011
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Provider Practice Location Address
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Address Line | 1724 N MAIN ST
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City | HAZARD
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State | KY
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Zip | 41701-1278
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Country | US
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Telephone | 606-439-4581
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Fax | 606-439-2873
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Provider Business Mailing Address
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Address Line | 1724 N MAIN ST
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City | HAZARD
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State | KY
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Zip | 41701-1278
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Country | US
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Telephone | 606-439-4581
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Fax | 606-439-2873
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAMES MARVIN JOLLY JR.
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Credential | D.M.D
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Telephone | 606-439-4581
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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 | 5604
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License Number State | KY
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