Provider Demographics
NPI:1679741037
Name:DOAN, JILL E (DDS MS)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:E
Last Name:DOAN
Suffix:
Gender:F
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 W JACKSON BLVD
Mailing Address - Street 2:SUITE 1275
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-6972
Mailing Address - Country:US
Mailing Address - Phone:312-588-0112
Mailing Address - Fax:312-588-0398
Practice Address - Street 1:223 W JACKSON BLVD
Practice Address - Street 2:SUITE 1275
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60606-6908
Practice Address - Country:US
Practice Address - Phone:312-588-0112
Practice Address - Fax:312-588-0398
Is Sole Proprietor?:No
Enumeration Date:2008-02-19
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-027357122300000X
IL021-0022351223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223P0300XDental ProvidersDentistPeriodontics