Provider Demographics
NPI:1750873725
Name:JOLLEY, MARC ALAN (DDS)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:ALAN
Last Name:JOLLEY
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 1:428 W 2300 N
Mailing Address - Street 2:
Mailing Address - City:HARRISVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84414-7040
Mailing Address - Country:US
Mailing Address - Phone:801-875-0857
Mailing Address - Fax:
Practice Address - Street 1:2797 N HWY 89 STE 201
Practice Address - Street 2:
Practice Address - City:PLEASANT VIEW
Practice Address - State:UT
Practice Address - Zip Code:84404-1231
Practice Address - Country:US
Practice Address - Phone:385-215-7222
Practice Address - Fax:801-737-5100
Is Sole Proprietor?:No
Enumeration Date:2018-06-05
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7683946122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist