| Organization Name: | RK JOLLEY DDS, PC |
| NPI Number: | 1134523459 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RICHARD K JOLLEY (CO-OWNER) |
| Mailing Address: | 40 W 100 N Vernal |
| State: | UT US |
| Postal Code: | 840782002 |
| Phone Number: | 4357892888 |
| Fax Number: | 4357897281 |
| NPI Enumeration Date: | 10/15/2014 |
| NPI Last Update Date: | 10/15/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 137338 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | UT |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |