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General NPI Number Information
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NPI Number | 1932774395
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Entity Type | Individual
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Provider Name | RICHARD KEATON JOLLEY DMD
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Gender | Male
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Dates
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Enumeration Date | 05/26/2021
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Last Update Date | 08/12/2022
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Provider Practice Location Address
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Address Line | 601 28 1/4 RD UNIT E
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City | GRAND JUNCTION
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State | CO
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Zip | 81506-6022
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Country | US
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Telephone | 570-523-6333
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Fax |
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Provider Business Mailing Address
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Address Line | 600 MANOR GLEN DR
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City | SUWANEE
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State | GA
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Zip | 30024-3517
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Country | US
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Telephone | 801-361-6446
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DEN.00204147
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License Number State | CO
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