Provider Demographics
NPI:1063950467
Name:DAVID B. JOLLEY, DMD, MS, PLLC
Entity type:Organization
Organization Name:DAVID B. JOLLEY, DMD, MS, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:JOLLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:702-875-3212
Mailing Address - Street 1:5756 S STAPLES ST STE A3
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78413-3782
Mailing Address - Country:US
Mailing Address - Phone:361-993-2333
Mailing Address - Fax:361-993-3200
Practice Address - Street 1:5756 S STAPLES ST STE A3
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78413-3782
Practice Address - Country:US
Practice Address - Phone:361-993-2333
Practice Address - Fax:361-993-3200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-06
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX318491223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty