Provider Demographics
NPI:1497761456
Name:CARRE, JILL R (DMD)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:R
Last Name:CARRE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3404 DERRY ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17111-1834
Mailing Address - Country:US
Mailing Address - Phone:717-561-1209
Mailing Address - Fax:717-561-4033
Practice Address - Street 1:3404 DERRY ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17111-1834
Practice Address - Country:US
Practice Address - Phone:717-561-1209
Practice Address - Fax:717-561-4033
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0357411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1572844OtherUCCI