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General NPI Number Information
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NPI Number | 1699187641
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Entity Type | Individual
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Provider Name | JIL KRISTINE DERY D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 05/27/2014
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Last Update Date | 05/25/2023
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Provider Practice Location Address
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Address Line | 5656 WARD WAY
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City | ARVADA
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State | CO
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Zip | 80002-1345
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Country | US
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Telephone | 720-316-4053
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Fax |
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Provider Business Mailing Address
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Address Line | 2418 NEWTON ST
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City | DENVER
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State | CO
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Zip | 80211-4446
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Country | US
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Telephone | 248-514-8960
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 2901021213
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License Number State | MI
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