Provider Demographics
NPI:1801202098
Name:SAKARIASON, JILLIAN KRISTINA (DDS)
Entity Type:Individual
Prefix:DR
First Name:JILLIAN
Middle Name:KRISTINA
Last Name:SAKARIASON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:JILLIAN
Other - Middle Name:KRISTINA
Other - Last Name:CYPHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:110 E ROUTT AVE
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81004-2117
Mailing Address - Country:US
Mailing Address - Phone:719-543-8711
Mailing Address - Fax:719-585-3057
Practice Address - Street 1:2030 LAKE AVE
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-3536
Practice Address - Country:US
Practice Address - Phone:719-543-8711
Practice Address - Fax:719-585-3057
Is Sole Proprietor?:No
Enumeration Date:2014-07-08
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00202745122300000X
NMDD4139122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist