Provider Demographics
NPI:1467760181
Name:JOLLY, PRISCILLA ALMOND (DMD)
Entity Type:Individual
Prefix:DR
First Name:PRISCILLA
Middle Name:ALMOND
Last Name:JOLLY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 HIGHLAND COLONY PKWY
Mailing Address - Street 2:SUITE 7201
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-2073
Mailing Address - Country:US
Mailing Address - Phone:601-605-2400
Mailing Address - Fax:
Practice Address - Street 1:1000 HIGHLAND COLONY PKWY
Practice Address - Street 2:SUITE 7201
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-2073
Practice Address - Country:US
Practice Address - Phone:601-879-4746
Practice Address - Fax:877-335-7218
Is Sole Proprietor?:No
Enumeration Date:2010-09-15
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3458-08122300000X
MSOR-435-101223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist