Provider Demographics
NPI:1013177922
Name:JAMES K. JOLLY, D.D.S, PA
Entity Type:Organization
Organization Name:JAMES K. JOLLY, D.D.S, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:FRANCES
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-633-7117
Mailing Address - Street 1:1819 E INNES ST
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28146-6121
Mailing Address - Country:US
Mailing Address - Phone:704-633-7117
Mailing Address - Fax:704-633-4637
Practice Address - Street 1:1819 E INNES ST
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28146-6121
Practice Address - Country:US
Practice Address - Phone:704-633-7117
Practice Address - Fax:704-633-4637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-13
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8556261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental