Provider Demographics
NPI:1265684823
Name:JOLLEY, CAMERON J (DMD, MSD)
Entity Type:Individual
Prefix:DR
First Name:CAMERON
Middle Name:J
Last Name:JOLLEY
Suffix:
Gender:M
Credentials:DMD, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 TROPHY CLUB DR # 100
Mailing Address - Street 2:
Mailing Address - City:TROPHY CLUB
Mailing Address - State:TX
Mailing Address - Zip Code:76262-5582
Mailing Address - Country:US
Mailing Address - Phone:817-491-1600
Mailing Address - Fax:
Practice Address - Street 1:925 TROPHY CLUB DR # 100
Practice Address - Street 2:
Practice Address - City:TROPHY CLUB
Practice Address - State:TX
Practice Address - Zip Code:76262-5582
Practice Address - Country:US
Practice Address - Phone:817-491-1600
Practice Address - Fax:817-490-9594
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-15
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX242161223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics