Provider Demographics
NPI:1164651329
Name:DENSON, JILL SUZANNE (DDS)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:SUZANNE
Last Name:DENSON
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 1:837 WOODLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-4067
Mailing Address - Country:US
Mailing Address - Phone:817-929-6749
Mailing Address - Fax:
Practice Address - Street 1:700 N PEARL ST
Practice Address - Street 2:SUITE 218N
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201-2824
Practice Address - Country:US
Practice Address - Phone:817-929-6749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-09
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24817122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist