Provider Demographics
NPI:1437383395
Name:JOLLY SMILES, P.A.
Entity Type:Organization
Organization Name:JOLLY SMILES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEENA
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:JOLLY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:302-378-3384
Mailing Address - Street 1:102 SLEEPY HOLLOW DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-5841
Mailing Address - Country:US
Mailing Address - Phone:302-378-3384
Mailing Address - Fax:302-338-8008
Practice Address - Street 1:102 SLEEPY HOLLOW DR
Practice Address - Street 2:SUITE 100
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-5841
Practice Address - Country:US
Practice Address - Phone:302-378-3384
Practice Address - Fax:302-338-8008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-06
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG-00010351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty