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General NPI Number Information
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NPI Number | 1851472658
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Entity Type | Organization
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Legal Business Name | R K JOLLEY DDS PC
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Dates
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Enumeration Date | 10/18/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 400 WEST 100 NORTH
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City | VERNAL
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State | UT
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Zip | 84078
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Country | US
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Telephone | 435-789-2888
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Fax |
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Provider Business Mailing Address
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Address Line | 400 WEST 100 NORTH
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City | VERNAL
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State | UT
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Zip | 84078
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Country | US
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Telephone | 435-789-2888
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Fax |
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Authorized Official
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Title or Position | CO PRESIDENTS
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Name | RICHARD K JOLLEY
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Credential | DDS PC
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Telephone | 435-789-2888
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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 | 1393669922
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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 | 1373389922
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License Number State | UT
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