Provider Demographics
NPI:1598101883
Name:JESSICA L KILE DDS LLC
Entity Type:Organization
Organization Name:JESSICA L KILE DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:L
Authorized Official - Last Name:KILE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:937-834-2252
Mailing Address - Street 1:18 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43044-1111
Mailing Address - Country:US
Mailing Address - Phone:937-834-2252
Mailing Address - Fax:
Practice Address - Street 1:18 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:OH
Practice Address - Zip Code:43044-1111
Practice Address - Country:US
Practice Address - Phone:937-834-2252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-14
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH23742122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1639420920OtherNPI INDIVIDUAL
OH23742OtherOHIO LICENSE