Healthcare Provider Details

I. General information

NPI: 1992416754
Provider Name (Legal Business Name): JILLIAN JEAN SINCLAIR RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JILLIAN JEAN TERRILL RDH

II. Dates (important events)

Enumeration Date: 12/12/2022
Last Update Date: 12/12/2022
Certification Date: 12/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

US ARMY DENTAC FT. JACKSON 4323 HILL ST.
COLUMBIA SC
29207
US

IV. Provider business mailing address

2100 TWIN LAKES RD
COLUMBIA SC
29209-2944
US

V. Phone/Fax

Practice location:
  • Phone: 803-751-6209
  • Fax:
Mailing address:
  • Phone: 207-416-5085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number12010
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: