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NPI Code Detail

MEDICARE: JEENA MARY JOLLY DDS

MEDICARE:   JEENA MARY JOLLY  DDS
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
1122300000XDentistG1-0001035DE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1952407884
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEENA MARY JOLLY DDS
Provider Business Mailing Address
First Line : 102 SLEEPY HOLLOW DR
Second Line : SUITE 100
City : MIDDLETOWN
State : DE
Zip : 19709-5841
Country : US
Telephone Number : 302-378-3384
Fax Number : 302-338-8008
Provider Business Practice Location Address
First Line : 102 SLEEPY HOLLOW DR
Second Line : SUITE 100
City : MIDDLETOWN
State : DE
Zip : 19709-5841
Country : US
Telephone Number : 302-378-3384
Fax Number : 302-338-8008
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/16/2006
Last Update Date : 09/13/2010

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Directions to “ JEENA MARY JOLLY DDS” Practice Location

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