Provider Demographics
NPI:1124186226
Name:DONALDSON, JILL M (DDS)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:M
Last Name:DONALDSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MRS
Other - First Name:JILL
Other - Middle Name:DONALDSON
Other - Last Name:OERTLING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2960 E GAUSE BLVD
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461
Mailing Address - Country:US
Mailing Address - Phone:985-641-3988
Mailing Address - Fax:985-646-2536
Practice Address - Street 1:2960 E GAUSE BLVD
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461
Practice Address - Country:US
Practice Address - Phone:985-641-3988
Practice Address - Fax:985-646-2536
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA51781223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1815178Medicaid