Provider Demographics
NPI:1962849117
Name:SAMELA, JILLIAN HELENE (DDS)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:HELENE
Last Name:SAMELA
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 1:8701 N CREEKWOOD CT
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-9381
Mailing Address - Country:US
Mailing Address - Phone:765-749-5994
Mailing Address - Fax:
Practice Address - Street 1:1678 FRY RD STE B
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-1176
Practice Address - Country:US
Practice Address - Phone:317-449-8054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-29
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1856253122300000X
IN12013421A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist