Provider Demographics
NPI:1881338358
Name:ABBOTT, JILANN JESSICA (RDH)
Entity type:Individual
Prefix:
First Name:JILANN
Middle Name:JESSICA
Last Name:ABBOTT
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:JILANN
Other - Middle Name:JESSICA
Other - Last Name:BRENIMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1021 N DAVIS ST
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-3535
Mailing Address - Country:US
Mailing Address - Phone:406-461-3425
Mailing Address - Fax:
Practice Address - Street 1:121 N LAST CHANCE GULCH STE E
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-4105
Practice Address - Country:US
Practice Address - Phone:406-443-5526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-21
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTDEN-RDH11559124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist