Susan D. Jolliff, D.D.S.
Individual provider Active NPI General Practice Dentistry · Brady, TX
NPI 1003857442 · NPPES record last updated Sep 3, 2019
Key facts
- NPI
- 1003857442
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 20448 (TX)
- Practice address
- 702 W 17TH St
Brady, TX 76825-6936 - Phone
- (325) 597-7441
- Fax
- (325) 597-0380
- NPI assigned
- Jun 9, 2006
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
- Opted out of Medicare
- Yes, effective Apr 10, 2017 through Apr 10, 2027
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20448 | TX | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Brady Dental Group, PA | Durable Medical Equipment & Medical Supplies | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | 20448 | TX | |
| General Practice Dentistry | 1223G0001X | 20448 | TX | Yes |
Addresses
Primary practice location
702 W 17TH St
Brady, TX 76825-6936
Mailing address
702 W 17TH St
Brady, TX 76825-6936
Phone (325) 597-7441
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 164258901 | Medicaid | TX | |
| B20448 | Other | TX | CHIPS |
Other providers in Brady, TX
- Sueellen Hernandez
- Kevin Daniel Hodnett
- Jana Gay Holubec
- Suzanne Holubec
- Kimberly Regina Huseman
- Alexandria Elaine Jordan
- Kevin Hodnett MD PLLC
- Marion Jo Kitsmiller
- Ronald Dean Klein
- Mary Lowe
All providers in Brady, TX · General Practice Dentistry in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 3, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Opt Out Affidavits (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.