Active NPI
Maxie Gene Jolley III, DMD
- General Practice Dentistry
- Morehead City, NC
National Provider Identifier
1942939830
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 12766
- Practice address
- 208 Professional Cir
Morehead City, NC 28557-4302 - Phone
- (252) 247-3010
- NPI assigned
- Jun 7, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 12766 | NC | Primary |
Addresses
Primary practice location
208 Professional Cir
Morehead City, NC 28557-4302
Mailing address
4005 Galantis Dr Apt 206D
Morehead City, NC 28557-0105
Phone (252) 722-1886
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Feb 8, 2023 through Feb 8, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12766 | NC | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1654560000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1654560000000",
"number": "1942939830",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4005 GALANTIS DR APT 206D",
"city": "MOREHEAD CITY",
"state": "NC",
"postal_code": "285570105",
"telephone_number": "252-722-1886"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "208 PROFESSIONAL CIR",
"city": "MOREHEAD CITY",
"state": "NC",
"postal_code": "285574302",
"telephone_number": "252-247-3010"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOLLEY",
"first_name": "MAXIE",
"middle_name": "GENE",
"name_prefix": "Dr.",
"name_suffix": "III",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-06-07",
"last_updated": "2022-06-07",
"certification_date": "2022-06-07",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"desc": "Dentist, General Practice",
"state": "NC",
"license": "12766",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Morehead City, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.