Provider Demographics
NPI:1558560623
Name:KINSELLA, JILL ANNE (DMD)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:ANNE
Last Name:KINSELLA
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 1:703 SEIBERT RD.
Mailing Address - Street 2:SUITE 5
Mailing Address - City:SCOTT AFB
Mailing Address - State:IL
Mailing Address - Zip Code:62225
Mailing Address - Country:US
Mailing Address - Phone:618-744-1969
Mailing Address - Fax:618-744-1986
Practice Address - Street 1:703 SEIBERT RD.
Practice Address - Street 2:SUITE 5
Practice Address - City:SCOTT AFB
Practice Address - State:IL
Practice Address - Zip Code:62225
Practice Address - Country:US
Practice Address - Phone:618-744-1969
Practice Address - Fax:618-744-1986
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-027404122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist