Provider Demographics
NPI:1073632220
Name:SELF-PIKE, JILL ELIZABETH (DMD)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:ELIZABETH
Last Name:SELF-PIKE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3710 SOUTHERN HILLS BLVD STE 700
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-8094
Mailing Address - Country:US
Mailing Address - Phone:479-936-8600
Mailing Address - Fax:479-636-1755
Practice Address - Street 1:3710 SOUTHERN HILLS BLVD STE 700
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8094
Practice Address - Country:US
Practice Address - Phone:479-254-8111
Practice Address - Fax:479-254-8112
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR34031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice