Provider Demographics
NPI:1588763528
Name:JOLLEY, TYLER H (DMD)
Entity type:Individual
Prefix:DR
First Name:TYLER
Middle Name:H
Last Name:JOLLEY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 28 1/4 RD
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:970-858-4446
Mailing Address - Fax:970-858-6436
Practice Address - Street 1:601 28 1/4 RD
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:970-858-4446
Practice Address - Fax:970-858-6436
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO91431223P0300X, 1223X0400X
UT533187299221223P0300X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No1223P0300XDental ProvidersDentistPeriodontics