1629245170 NPI number — DENTAL SERVICES OF OHIO, DANIEL JOLLY, DDS, INC

Table of content: (NPI 1629245170)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629245170 NPI number — DENTAL SERVICES OF OHIO, DANIEL JOLLY, DDS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DENTAL SERVICES OF OHIO, DANIEL JOLLY, DDS, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629245170
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/07/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 11568
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OVERLAND PARK
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66207-4268
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-428-1670
Provider Business Mailing Address Fax Number:
866-591-0604

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1494 S ARLINGTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AKRON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-724-7036
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/14/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
JOLLY
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
Authorized Official Title or Position:
PC PRESIDENT
Authorized Official Telephone Number:
614-473-0400

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  30021038 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)