MEDICARE: DR. PRISCILLA ALMOND JOLLY D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	3458-08	MS
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	OR-435-10	MS

General Provider Information

NPI Number	:	1467760181
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PRISCILLA ALMOND JOLLY D.M.D.

Provider Business Mailing Address
First Line	:	1000 HIGHLAND COLONY PKWY
Second Line	:	SUITE 7201
City	:	RIDGELAND
State	:	MS
Zip	:	39157-2073
Country	:	US
Telephone Number	:	601-605-2400
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 HIGHLAND COLONY PKWY
Second Line	:	SUITE 7201
City	:	RIDGELAND
State	:	MS
Zip	:	39157-2073
Country	:	US
Telephone Number	:	601-879-4746
Fax Number	:	877-335-7218

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2010
Last Update Date	:	11/30/2010

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