Provider Demographics
NPI:1922293315
Name:JOLLY, JAMES K (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:K
Last Name:JOLLY
Suffix:
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 1:1819 E INNES ST
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28146-6121
Mailing Address - Country:US
Mailing Address - Phone:704-633-7117
Mailing Address - Fax:704-633-4637
Practice Address - Street 1:1819 E INNES ST
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28146-6121
Practice Address - Country:US
Practice Address - Phone:704-633-7117
Practice Address - Fax:704-633-4637
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-10
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30020098122300000X
NC85561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist