MEDICARE: JILLIAN NOELE GRAY D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	30.024243	OH

General Provider Information

NPI Number	:	1821363755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILLIAN NOELE GRAY D.D.S.

Provider Business Mailing Address
First Line	:	148 AMAZON PL
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43214-3504
Country	:	US
Telephone Number	:	419-360-0097
Fax Number	:

Provider Business Practice Location Address
First Line	:	4472 N HIGH ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43214-2604
Country	:	US
Telephone Number	:	614-852-3622
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2012
Last Update Date	:	09/21/2018

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