Provider Demographics
NPI:1336641109
Name:ISMAIL JOLAOSO, DDS, P.C.
Entity Type:Organization
Organization Name:ISMAIL JOLAOSO, DDS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ISMAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:JOLAOSO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:434-447-2492
Mailing Address - Street 1:1165 E ATLANTIC ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH HILL
Mailing Address - State:VA
Mailing Address - Zip Code:23970-9547
Mailing Address - Country:US
Mailing Address - Phone:434-447-2492
Mailing Address - Fax:
Practice Address - Street 1:1165 E ATLANTIC ST
Practice Address - Street 2:
Practice Address - City:SOUTH HILL
Practice Address - State:VA
Practice Address - Zip Code:23970-9547
Practice Address - Country:US
Practice Address - Phone:434-447-2492
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-07
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty