Provider Demographics
NPI:1710198338
Name:HOUSTON, JILL M (DDS)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:M
Last Name:HOUSTON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8853 ROCKVILLE RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46234-2731
Mailing Address - Country:US
Mailing Address - Phone:317-271-2000
Mailing Address - Fax:317-271-2900
Practice Address - Street 1:8853 ROCKVILLE RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46234-2731
Practice Address - Country:US
Practice Address - Phone:317-271-2000
Practice Address - Fax:317-271-2900
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120095681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice