Provider Demographics
NPI:1942924014
Name:BREWER, JILL MARION (RDH)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:MARION
Last Name:BREWER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 N VAN DORN ST STE 128
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22302-1601
Mailing Address - Country:US
Mailing Address - Phone:703-894-4867
Mailing Address - Fax:
Practice Address - Street 1:2500 N VAN DORN ST STE 128
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22302-1601
Practice Address - Country:US
Practice Address - Phone:703-894-4867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0402204812124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist