Provider Demographics
NPI:1699207258
Name:JILG, KRISTEN FISCHER (DMD)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:FISCHER
Last Name:JILG
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 1:6 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:SNOW HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28580-1333
Mailing Address - Country:US
Mailing Address - Phone:252-747-3846
Mailing Address - Fax:
Practice Address - Street 1:6 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:SNOW HILL
Practice Address - State:NC
Practice Address - Zip Code:28580-1333
Practice Address - Country:US
Practice Address - Phone:252-747-3846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-31
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program