Provider Demographics
NPI:1790835999
Name:JILL G BRION DDS PLLC
Entity Type:Organization
Organization Name:JILL G BRION DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:G
Authorized Official - Last Name:BRION
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:810-987-7511
Mailing Address - Street 1:1978 HOLLAND AVE
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060
Mailing Address - Country:US
Mailing Address - Phone:810-987-7511
Mailing Address - Fax:810-987-7513
Practice Address - Street 1:1978 HOLLAND AVE
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060
Practice Address - Country:US
Practice Address - Phone:810-987-7511
Practice Address - Fax:810-987-7513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty