Provider Demographics
NPI:1518003292
Name:ROWLAND, JILL A (DDS)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:A
Last Name:ROWLAND
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 1:91 FORDHAM DR
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14216-3111
Mailing Address - Country:US
Mailing Address - Phone:716-874-4390
Mailing Address - Fax:
Practice Address - Street 1:1909 PINE AVE
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14301-2309
Practice Address - Country:US
Practice Address - Phone:716-282-4641
Practice Address - Fax:716-282-0958
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050909-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY9182087OtherFIDELIS PROVIDER #
NY02587557Medicaid