Provider Demographics
NPI:1508902305
Name:BISSON, JEFFREY J (DMD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:J
Last Name:BISSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:482 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-3117
Mailing Address - Country:US
Mailing Address - Phone:203-272-2729
Mailing Address - Fax:203-272-9886
Practice Address - Street 1:482 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-3117
Practice Address - Country:US
Practice Address - Phone:203-272-2729
Practice Address - Fax:203-272-9886
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT77741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice