Healthcare Provider Details

I. General information

NPI: 1003109877
Provider Name (Legal Business Name): JILL LAURIE GARRIDO D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2011
Last Update Date: 03/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 FOULK RD STE C
WILMINGTON DE
19810-3642
US

IV. Provider business mailing address

319 W MERMAID LN
PHILADELPHIA PA
19118-4009
US

V. Phone/Fax

Practice location:
  • Phone: 302-475-3110
  • Fax:
Mailing address:
  • Phone: 717-575-8929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDS038649
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: