Provider Demographics
NPI:1407293558
Name:JAROSKI-GRAF, JILL ANN (RDH)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:ANN
Last Name:JAROSKI-GRAF
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 128
Mailing Address - Street 2:128 OLD ABE ROAD
Mailing Address - City:LAC DU FLAMBEAU
Mailing Address - State:WI
Mailing Address - Zip Code:54538-0128
Mailing Address - Country:US
Mailing Address - Phone:715-588-4280
Mailing Address - Fax:715-588-2480
Practice Address - Street 1:128 OLD ABE ROAD
Practice Address - Street 2:
Practice Address - City:LAC DU FLAMBEAU
Practice Address - State:WI
Practice Address - Zip Code:54538-0128
Practice Address - Country:US
Practice Address - Phone:715-588-4280
Practice Address - Fax:715-588-2480
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-30
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2812-16124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist