Provider Demographics
NPI:1649593724
Name:BENETTI, JILL (RDH, BSDH)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:BENETTI
Suffix:
Gender:F
Credentials:RDH, BSDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:831 ELLIOTT RD
Mailing Address - Street 2:
Mailing Address - City:COWICHE
Mailing Address - State:WA
Mailing Address - Zip Code:98923-9772
Mailing Address - Country:US
Mailing Address - Phone:509-678-4091
Mailing Address - Fax:
Practice Address - Street 1:831 ELLIOTT RD
Practice Address - Street 2:
Practice Address - City:COWICHE
Practice Address - State:WA
Practice Address - Zip Code:98923-9772
Practice Address - Country:US
Practice Address - Phone:509-678-4091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-03
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602759155124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist