Healthcare Provider Details

I. General information

NPI: 1215320999
Provider Name (Legal Business Name): JILLIAN SNARE DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2015
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 S PARK AVE STE 6
TUCSON AZ
85714-1697
US

IV. Provider business mailing address

4650 W MONTANA ST
TUCSON AZ
85757-8671
US

V. Phone/Fax

Practice location:
  • Phone: 520-889-3358
  • Fax:
Mailing address:
  • Phone: 520-373-7280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number30.024047
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number9843
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: