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General NPI Number Information
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NPI Number | 1750873725
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Entity Type | Individual
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Provider Name | MARC ALAN JOLLEY DDS
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Gender | Male
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Dates
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Enumeration Date | 06/05/2018
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Last Update Date | 06/05/2018
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Provider Practice Location Address
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Address Line | 2797 N HWY 89 STE 201
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City | PLEASANT VIEW
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State | UT
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Zip | 84404-1231
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Country | US
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Telephone | 385-215-7222
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Fax | 801-737-5100
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Provider Business Mailing Address
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Address Line | 428 W 2300 N
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City | HARRISVILLE
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State | UT
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Zip | 84414-7040
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Country | US
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Telephone | 801-875-0857
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 7683946
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 7683946
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License Number State | UT
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