Individual
ELLIOTT JOLLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
582 N 1700 W, VERNAL, UT 84078-8200
(435) 781-1234
Mailing address
582 N 1700 W, VERNAL, UT 84078-8200
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
8079919-9922
UT
Other
Enumeration date
06/25/2012
Last updated
06/25/2012
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