Individual ProviderJill MerrillDentistDental ProvidersPractice Address840 N 87th St, Milwaukee, WI 53226-3586(414) 805-5760(414) 456-5006PECOS EnrollmentBased on the most recent information from CMS, provider Jill Merrill is legally eligible to order and refer claims for Part B, HHA and DME services only.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 3 days ago.Profile DetailsProvider ID1659575314Provider TypeIndividualFull NameMerrill, JillTitleDr.CredentialDDSGenderFemaleSole ProprietorNoEnumeration Date6/14/2007Last Updated2/18/2009Contact InformationPractice LocationPractice Address840 N 87th St, Milwaukee, WI 53226-3586Phone(414) 805-5760FaxUnlisted FaxMailing LocationMailing Address10000 W Innovation Dr, Milwaukee, WI 53226-4837Phone(414) 456-5006Fax(414) 456-6259Provider TaxonomiesCodeDescriptionLicenseCode1223S0112XPrimaryDescriptionDentistDental ProvidersLicense6169WisconsinCode1223S0112XDescriptionDentistDental ProvidersLicenseD11533MinnesotaProvider IdentifiersIDDescriptionIssuerID33815800DescriptionMedicaidIssuerUnlistedWisconsin