Richard Kirkham Jolley
Individual provider Active NPI Dentist · Vernal, UT
NPI 1902200223 · NPPES record last updated Mar 4, 2015
Key facts
- NPI
- 1902200223
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 137338 (UT)
- Practice address
- 40 W 100 N
Vernal, UT 84078-2002 - Phone
- (435) 789-2888
- Fax
- (435) 789-7281
- NPI assigned
- Oct 15, 2014
- Sex
- Male
- Sole proprietor
- No
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 Mar 16, 2016 through Mar 16, 2028
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 137338 | UT | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| RK Jolley DDS, PC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 137338 | UT | Yes |
Addresses
Primary practice location
40 W 100 N
Vernal, UT 84078-2002
Mailing address
40 W 100 N
Vernal, UT 84078-2002
Phone (435) 789-2888
Other providers in Vernal, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 4, 2015. 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.