Provider Demographics
NPI:1639738453
Name:STILL, JESSIE GAIL (DMD)
Entity Type:Individual
Prefix:DR
First Name:JESSIE
Middle Name:GAIL
Last Name:STILL
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 1:300 BEECH CIR APT 7102
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35213-2055
Mailing Address - Country:US
Mailing Address - Phone:334-672-2879
Mailing Address - Fax:
Practice Address - Street 1:205 CALDWELL DR
Practice Address - Street 2:
Practice Address - City:WARRIOR
Practice Address - State:AL
Practice Address - Zip Code:35180-1407
Practice Address - Country:US
Practice Address - Phone:334-672-2879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-06
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0006633-C11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice