Provider Demographics
NPI:1457305351
Name:DEBUSK, ALFRED JAY JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:JAY
Last Name:DEBUSK
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3806POWERS AVE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37917-2634
Mailing Address - Country:US
Mailing Address - Phone:865-688-5531
Mailing Address - Fax:
Practice Address - Street 1:3806 POWERS ST
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37917-2635
Practice Address - Country:US
Practice Address - Phone:865-688-5531
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS28351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice