Provider Demographics
NPI:1144321613
Name:TRUXILLO, JILL ANN (DDS)
Entity type:Individual
Prefix:DR
First Name:JILL
Middle Name:ANN
Last Name:TRUXILLO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18201 FALLER RD
Mailing Address - Street 2:
Mailing Address - City:TICKFAW
Mailing Address - State:LA
Mailing Address - Zip Code:70466
Mailing Address - Country:US
Mailing Address - Phone:985-419-0828
Mailing Address - Fax:
Practice Address - Street 1:20204 HWY 190 E.
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70401
Practice Address - Country:US
Practice Address - Phone:985-662-5550
Practice Address - Fax:985-662-5552
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA55921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice