Provider Demographics
NPI:1003128208
Name:TETRICK, JILL NOELLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:NOELLE
Last Name:TETRICK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3628 MERIDIAN ST STE 1C
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1735
Mailing Address - Country:US
Mailing Address - Phone:360-734-4374
Mailing Address - Fax:360-715-9196
Practice Address - Street 1:3628 MERIDIAN ST STE 1C
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1735
Practice Address - Country:US
Practice Address - Phone:360-734-4374
Practice Address - Fax:360-715-9196
Is Sole Proprietor?:No
Enumeration Date:2010-07-06
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602154801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice