Provider Demographics
NPI:1679568026
Name:KINZER, JILL ELLEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:ELLEN
Last Name:KINZER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:ELLEN
Other - Last Name:NYBOER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:600 BROADWAY STE 490
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-5312
Mailing Address - Country:US
Mailing Address - Phone:206-223-0033
Mailing Address - Fax:253-853-6681
Practice Address - Street 1:600 BROADWAY STE 490
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-5312
Practice Address - Country:US
Practice Address - Phone:206-223-0033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAWA87401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice