Healthcare Provider Details

I. General information

NPI: 1922394790
Provider Name (Legal Business Name): JILLIAN NOELLE STORR DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2011
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

349 SUMMER SPARROW AVE
HENDERSON NV
89011-4526
US

IV. Provider business mailing address

349 SUMMER SPARROW AVE
HENDERSON NV
89011-4526
US

V. Phone/Fax

Practice location:
  • Phone: 702-833-0281
  • Fax:
Mailing address:
  • Phone: 702-833-0281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number2012032807
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8116
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number9325
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: