Provider Demographics
NPI:1881153286
Name:FERDINA, JILL RANAE
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:RANAE
Last Name:FERDINA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 EAST 13TH STREET
Mailing Address - Street 2:
Mailing Address - City:POPLAT
Mailing Address - State:MT
Mailing Address - Zip Code:59255
Mailing Address - Country:US
Mailing Address - Phone:406-768-3383
Mailing Address - Fax:
Practice Address - Street 1:415 4TH AVE S
Practice Address - Street 2:
Practice Address - City:WOLF POINT
Practice Address - State:MT
Practice Address - Zip Code:59201-1639
Practice Address - Country:US
Practice Address - Phone:406-653-1653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-15
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist