Provider Demographics
NPI:1922394790
Name:STORR, JILLIAN NOELLE (DMD)
Entity type:Individual
Prefix:DR
First Name:JILLIAN
Middle Name:NOELLE
Last Name:STORR
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:349 SUMMER SPARROW AVE
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89011-4526
Mailing Address - Country:US
Mailing Address - Phone:702-833-0281
Mailing Address - Fax:
Practice Address - Street 1:349 SUMMER SPARROW AVE
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89011-4526
Practice Address - Country:US
Practice Address - Phone:702-833-0281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-21
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV81161223G0001X
MO2012032807122300000X
TN93251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist