Provider Demographics
NPI:1710991963
Name:JOLLYMOUR, ARTHUR PETER III (DDS)
Entity Type:Individual
Prefix:DR
First Name:ARTHUR
Middle Name:PETER
Last Name:JOLLYMOUR
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:888 OAK GROVE AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-4428
Mailing Address - Country:US
Mailing Address - Phone:650-322-1864
Mailing Address - Fax:
Practice Address - Street 1:888 OAK GROVE AVE STE 3
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-4428
Practice Address - Country:US
Practice Address - Phone:650-322-1864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA347211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice