Provider Demographics
NPI:1194959726
Name:DIDYK, JILL MARIE (DMD)
Entity type:Individual
Prefix:DR
First Name:JILL
Middle Name:MARIE
Last Name:DIDYK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10610 MEETING ST UNIT 101
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:KY
Mailing Address - Zip Code:40059-6513
Mailing Address - Country:US
Mailing Address - Phone:502-339-4500
Mailing Address - Fax:502-385-0555
Practice Address - Street 1:10610 MEETING ST UNIT 101
Practice Address - Street 2:
Practice Address - City:PROSPECT
Practice Address - State:KY
Practice Address - Zip Code:40059-6513
Practice Address - Country:US
Practice Address - Phone:502-339-4500
Practice Address - Fax:502-385-0555
Is Sole Proprietor?:No
Enumeration Date:2009-05-11
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY87301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice