Provider Demographics
NPI:1396033106
Name:ALDRICH, JILL CARSON (DDS)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:CARSON
Last Name:ALDRICH
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 1:10373 E COUNTY ROAD 100 N
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46234-1250
Mailing Address - Country:US
Mailing Address - Phone:463-701-5437
Mailing Address - Fax:463-209-0482
Practice Address - Street 1:10373 E COUNTY ROAD 100 N
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46234
Practice Address - Country:US
Practice Address - Phone:463-701-5437
Practice Address - Fax:463-209-0482
Is Sole Proprietor?:No
Enumeration Date:2011-07-13
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011675A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist