Provider Demographics
NPI:1972984359
Name:BALGAARD, JILL MARIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:MARIE
Last Name:BALGAARD
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 1:321 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:FERGUS FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56537-2403
Mailing Address - Country:US
Mailing Address - Phone:218-739-2481
Mailing Address - Fax:
Practice Address - Street 1:321 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-2403
Practice Address - Country:US
Practice Address - Phone:218-739-2481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-11
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND137271223G0001X
MTDEN-DEN-LIC-96061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice