Provider Demographics
NPI:1932239761
Name:JOLLY, RUPA (DDS)
Entity Type:Individual
Prefix:DR
First Name:RUPA
Middle Name:
Last Name:JOLLY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 TCHOUPITOULAS ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70130-2408
Mailing Address - Country:US
Mailing Address - Phone:504-528-7800
Mailing Address - Fax:504-528-7801
Practice Address - Street 1:307 TCHOUPITOULAS ST
Practice Address - Street 2:SUITE 200
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70130-2408
Practice Address - Country:US
Practice Address - Phone:504-528-7800
Practice Address - Fax:504-528-7801
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA55211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice