Provider Demographics
NPI:1245648237
Name:PERRY, JILLIAN ELIZABETH (DDS)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:ELIZABETH
Last Name:PERRY
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:PO BOX 2136
Mailing Address - Street 2:
Mailing Address - City:NOME
Mailing Address - State:AK
Mailing Address - Zip Code:99762-2136
Mailing Address - Country:US
Mailing Address - Phone:907-434-0450
Mailing Address - Fax:
Practice Address - Street 1:1000 GREG KRUSCHEK AVE
Practice Address - Street 2:
Practice Address - City:NOME
Practice Address - State:AK
Practice Address - Zip Code:99762-9998
Practice Address - Country:US
Practice Address - Phone:907-443-3309
Practice Address - Fax:907-443-3466
Is Sole Proprietor?:No
Enumeration Date:2014-07-23
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901021228122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist