Provider Demographics
NPI:1215475603
Name:JACOBS, JILL (RDH)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:JACOBS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:JACOBS
Other - Last Name:DEVEREUX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:8630 FENTON ST
Mailing Address - Street 2:SUITE 1204
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-3806
Mailing Address - Country:US
Mailing Address - Phone:301-340-7525
Mailing Address - Fax:301-495-0318
Practice Address - Street 1:200 GIRARD ST
Practice Address - Street 2:SUITE# 2016
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-3466
Practice Address - Country:US
Practice Address - Phone:240-720-0510
Practice Address - Fax:240-631-2280
Is Sole Proprietor?:No
Enumeration Date:2017-02-06
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD6810124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist