Provider Demographics
NPI:1851423941
Name:HENRY L. JOLLY, JR., D.M.D., P.C.
Entity Type:Organization
Organization Name:HENRY L. JOLLY, JR., D.M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:JOLLY
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:864-489-2221
Mailing Address - Street 1:914 S LIMESTONE ST
Mailing Address - Street 2:
Mailing Address - City:GAFFNEY
Mailing Address - State:SC
Mailing Address - Zip Code:29340-2126
Mailing Address - Country:US
Mailing Address - Phone:864-489-2221
Mailing Address - Fax:864-489-2171
Practice Address - Street 1:914 S LIMESTONE ST
Practice Address - Street 2:
Practice Address - City:GAFFNEY
Practice Address - State:SC
Practice Address - Zip Code:29340-2126
Practice Address - Country:US
Practice Address - Phone:864-489-2221
Practice Address - Fax:864-489-2171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC33701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty