Provider Demographics
NPI:1164629416
Name:MEDURE, JILLIAN KIMBERLY (DMD)
Entity Type:Individual
Prefix:DR
First Name:JILLIAN
Middle Name:KIMBERLY
Last Name:MEDURE
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 1:3630 SAINT JOHNS AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32205-9065
Mailing Address - Country:US
Mailing Address - Phone:904-387-0501
Mailing Address - Fax:904-387-3505
Practice Address - Street 1:3630 SAINT JOHNS AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32205-9065
Practice Address - Country:US
Practice Address - Phone:904-387-0501
Practice Address - Fax:904-387-3505
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052197122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist