Provider Demographics
NPI:1780706119
Name:WHITNEY, JILL DENE (DDS)
Entity type:Individual
Prefix:DR
First Name:JILL
Middle Name:DENE
Last Name:WHITNEY
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 1:10 CHICORY BEND CT
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-5769
Mailing Address - Country:US
Mailing Address - Phone:916-422-2864
Mailing Address - Fax:
Practice Address - Street 1:5665 FREEPORT BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95822-3517
Practice Address - Country:US
Practice Address - Phone:916-427-3003
Practice Address - Fax:916-427-4408
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA422521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice