Provider Demographics
NPI:1083843510
Name:EAGLES, JILL K (DMD)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:K
Last Name:EAGLES
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 1:400 WINDING WAY UNIT 19
Mailing Address - Street 2:
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335-3281
Mailing Address - Country:US
Mailing Address - Phone:610-873-1656
Mailing Address - Fax:
Practice Address - Street 1:400 WINDING WAY UNIT 19
Practice Address - Street 2:
Practice Address - City:DOWNINGTOWN
Practice Address - State:PA
Practice Address - Zip Code:19335-3281
Practice Address - Country:US
Practice Address - Phone:610-873-1656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-06
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS037871122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist