Provider Demographics
NPI:1053474353
Name:ELLNER, JILL DLABAL (DDS)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:DLABAL
Last Name:ELLNER
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 1:1640 CHARLES PL
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-0428
Mailing Address - Country:US
Mailing Address - Phone:785-537-8484
Mailing Address - Fax:785-537-2281
Practice Address - Street 1:1640 CHARLES PL
Practice Address - Street 2:SUITE 101
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-0428
Practice Address - Country:US
Practice Address - Phone:785-537-8484
Practice Address - Fax:785-537-2281
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS601151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice