Provider Demographics
NPI:1619191657
Name:HALCARZ, JILL (DDS)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:
Last Name:HALCARZ
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 1:1832 BEECH CT
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-8268
Mailing Address - Country:US
Mailing Address - Phone:219-226-9554
Mailing Address - Fax:
Practice Address - Street 1:1000 E 80TH PL STE 523
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-5608
Practice Address - Country:US
Practice Address - Phone:219-769-4246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010445A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice