Provider Demographics
NPI:1780938050
Name:QUAST, JILL RATCLIFFE (RDH)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:RATCLIFFE
Last Name:QUAST
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 SPRING GLEN DR
Mailing Address - Street 2:
Mailing Address - City:GRANBY
Mailing Address - State:CT
Mailing Address - Zip Code:06035-2624
Mailing Address - Country:US
Mailing Address - Phone:860-305-5410
Mailing Address - Fax:
Practice Address - Street 1:1750 MAIN ST
Practice Address - Street 2:SAND SCHOOL DENTAL CLINIC
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06120-2312
Practice Address - Country:US
Practice Address - Phone:860-695-5056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-07
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT02899124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist