Provider Demographics
NPI:1083708192
Name:MICHAELS, JILL FRANCIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:FRANCIS
Last Name:MICHAELS
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 1:331 W STATE HIGHWAY 6 STE D
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-5584
Mailing Address - Country:US
Mailing Address - Phone:254-772-0373
Mailing Address - Fax:
Practice Address - Street 1:331 W STATE HIGHWAY 6 STE D
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-5584
Practice Address - Country:US
Practice Address - Phone:254-772-0373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX158091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice