Provider Demographics
NPI:1992416754
Name:SINCLAIR, JILLIAN JEAN (RDH)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:JEAN
Last Name:SINCLAIR
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:JILLIAN
Other - Middle Name:JEAN
Other - Last Name:TERRILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:2100 TWIN LAKES RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29209-2944
Mailing Address - Country:US
Mailing Address - Phone:207-416-5085
Mailing Address - Fax:
Practice Address - Street 1:US ARMY DENTAC FT. JACKSON
Practice Address - Street 2:4323 HILL ST.
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29207
Practice Address - Country:US
Practice Address - Phone:803-751-6209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12010124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist