Provider Demographics
NPI:1982668992
Name:YORK, JILL A (DDS, MAS)
Entity type:Individual
Prefix:DR
First Name:JILL
Middle Name:A
Last Name:YORK
Suffix:
Gender:F
Credentials:DDS, MAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 RICHMOND ST
Mailing Address - Street 2:APARTMENT 4059
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-4100
Mailing Address - Country:US
Mailing Address - Phone:732-247-5437
Mailing Address - Fax:
Practice Address - Street 1:110 BERGEN ST
Practice Address - Street 2:ROOM B-847
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-2495
Practice Address - Country:US
Practice Address - Phone:973-972-0190
Practice Address - Fax:973-972-1166
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI018156001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice