| NPI | 1801143581 |
|---|---|
| Former Name | JILLIAN NICOLE DETTLOFF |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 34968) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901020632) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: OK 117) | |
| Enumeration Date | 2012-08-13 |
| Last Update Date | 2021-02-01 |