Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | DS038649 | PA |
NPI | 1003109877 |
---|---|
Provider Name | Jill Laurie Garrido |
First Address | Philadelphia, PA 19118-4009 |
Second Address | Wilmington, DE 19810-3642 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2011 |
Last Update Date | 22/03/2019 |