# CHANDLER MODERN DENTISTRY AND ORTHODONTICS, LLP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Chandler Modern Dentistry and Orthodontics
- **Organization subpart:** No

## Provider details

- **NPI number:** 1700222916
- **Authorized official:** DR. TYSON M JOLLEY DMD (OWNER)
- **Authorized official phone:** (480) 792-1543

## Contact information

- **Practice address:** 2875 W RAY RD STE 16, CHANDLER, AZ 85224-3619
- **Practice address phone:** (480) 792-1543
- **Practice address fax:** (480) 792-1544
- **Mailing address:** PO BOX 920050, DALLAS, TX 75392-0050
- **Mailing address phone:** (714) 845-8890
- **Mailing address fax:** (714) 845-8803

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 05/14/2013
- **Last updated:** 04/13/2022