Provider Demographics
NPI:1679365381
Name:GRILL, JAKE ANDREW (DDS)
Entity type:Individual
Prefix:
First Name:JAKE
Middle Name:ANDREW
Last Name:GRILL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 N CORTEZ ST APT 2339
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-4887
Mailing Address - Country:US
Mailing Address - Phone:318-560-7559
Mailing Address - Fax:
Practice Address - Street 1:4964 LAPALCO BLVD
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-4371
Practice Address - Country:US
Practice Address - Phone:318-560-7559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-19
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA76731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice