Provider Demographics
NPI:1255868998
Name:GUILES, JILL
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:GUILES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 COLTON LN
Mailing Address - Street 2:
Mailing Address - City:STAR LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:13690-3120
Mailing Address - Country:US
Mailing Address - Phone:315-323-8714
Mailing Address - Fax:
Practice Address - Street 1:4 COMMERCE LN
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:NY
Practice Address - Zip Code:13617-3739
Practice Address - Country:US
Practice Address - Phone:315-386-8191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-12
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025786124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist