Individual
LISA REBECCA JOLLY
Active
Individual
LISA REBECCA JOLLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
12328725-9921
UT
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
12328725-9921
UT
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
DS044929
PA
Other
Enumeration date
05/05/2021
Last updated
08/12/2026
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