Provider Demographics
NPI:1053540518
Name:MILLER, JILL ANN (DDS)
Entity type:Individual
Prefix:DR
First Name:JILL
Middle Name:ANN
Last Name:MILLER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:ANN
Other - Last Name:GRIFFO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:409 E KIRACOFE AVE
Mailing Address - Street 2:
Mailing Address - City:ELIDA
Mailing Address - State:OH
Mailing Address - Zip Code:45807-1031
Mailing Address - Country:US
Mailing Address - Phone:419-331-0031
Mailing Address - Fax:419-331-0039
Practice Address - Street 1:409 E KIRACOFE AVE
Practice Address - Street 2:
Practice Address - City:ELIDA
Practice Address - State:OH
Practice Address - Zip Code:45807-1031
Practice Address - Country:US
Practice Address - Phone:419-331-0031
Practice Address - Fax:419-331-0039
Is Sole Proprietor?:No
Enumeration Date:2009-07-06
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0230561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice