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General NPI Number Information
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NPI Number | 1689708984
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Entity Type | Individual
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Provider Name | JADILIA DDAS DMD
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Gender | Female
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Dates
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Enumeration Date | 03/16/2007
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Last Update Date | 02/03/2025
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Provider Practice Location Address
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Address Line | 219 FRONT ST
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City | BINGHAMTON
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State | NY
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Zip | 13905
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Country | US
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Telephone | 607-584-4545
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Fax | 607-584-4538
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Provider Business Mailing Address
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Address Line | 210 INTERSTATE NORTH PKWY SE STE 300
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City | ATLANTA
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State | GA
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Zip | 30339-2233
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN015972
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DI21204
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License Number State | NJ
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