Provider Demographics
NPI:1821363755
Name:GRAY, JILLIAN NOELE (DDS)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:NOELE
Last Name:GRAY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:JILLIAN
Other - Middle Name:NOELE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:148 AMAZON PL
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-3504
Mailing Address - Country:US
Mailing Address - Phone:419-360-0097
Mailing Address - Fax:
Practice Address - Street 1:4472 N HIGH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-2604
Practice Address - Country:US
Practice Address - Phone:614-852-3622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-10
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.024243122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist