Provider Demographics
NPI:1356993869
Name:JOLLY, NEENA BEATRICE (DMD)
Entity type:Individual
Prefix:DR
First Name:NEENA
Middle Name:BEATRICE
Last Name:JOLLY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14140 CORNUS CT
Mailing Address - Street 2:
Mailing Address - City:GALENA
Mailing Address - State:MD
Mailing Address - Zip Code:21635-1837
Mailing Address - Country:US
Mailing Address - Phone:302-362-7690
Mailing Address - Fax:
Practice Address - Street 1:102 SLEEPY HOLLOW DR STE 100
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-5841
Practice Address - Country:US
Practice Address - Phone:302-378-3384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-15
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0419531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice