Provider Demographics
NPI:1710320486
Name:GOLLY, FRANCES ELIZABETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:FRANCES
Middle Name:ELIZABETH
Last Name:GOLLY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16805 NW COBURG LN
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-5201
Mailing Address - Country:US
Mailing Address - Phone:509-954-7526
Mailing Address - Fax:
Practice Address - Street 1:641 NE HIGHWAY 99W
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-2708
Practice Address - Country:US
Practice Address - Phone:503-472-9435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-12
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD10435122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist