Provider Demographics
NPI:1407021496
Name:WEBER, JILL MARIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:MARIE
Last Name:WEBER
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 1:31099 CHAGRIN BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PEPPER PIKE
Mailing Address - State:OH
Mailing Address - Zip Code:44124-5958
Mailing Address - Country:US
Mailing Address - Phone:216-450-5888
Mailing Address - Fax:
Practice Address - Street 1:31099 CHAGRIN BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:PEPPER PIKE
Practice Address - State:OH
Practice Address - Zip Code:44124-5958
Practice Address - Country:US
Practice Address - Phone:216-450-5888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0233271223S0112X
IL019.0282001223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3075390Medicaid