Provider Demographics
NPI:1518956044
Name:JOLLY, BRADLEY EUGENE (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:EUGENE
Last Name:JOLLY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:785 OLD HICKORY BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-4512
Mailing Address - Country:US
Mailing Address - Phone:615-373-5930
Mailing Address - Fax:615-373-0222
Practice Address - Street 1:785 OLD HICKORY BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-4512
Practice Address - Country:US
Practice Address - Phone:615-373-5930
Practice Address - Fax:615-373-0222
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN73521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice