Provider Demographics
NPI:1144540444
Name:DR. TYLER H. JOLLEY, DMD PC DOING BUSINESS AS JOLLEY SMILES
Entity type:Organization
Organization Name:DR. TYLER H. JOLLEY, DMD PC DOING BUSINESS AS JOLLEY SMILES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:TONJA
Authorized Official - Middle Name:
Authorized Official - Last Name:CRONKHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-523-6333
Mailing Address - Street 1:601 28 1/4 RD UNIT E
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81506-6022
Mailing Address - Country:US
Mailing Address - Phone:970-523-6333
Mailing Address - Fax:
Practice Address - Street 1:601 28 1/4 RD UNIT E
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81506-6022
Practice Address - Country:US
Practice Address - Phone:970-523-6333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-09
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO91431223X0400X
1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty