Provider Demographics
NPI:1568651792
Name:DUBOIS, JEFFREY H (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:H
Last Name:DUBOIS
Suffix:
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 1:6246 E PIMA ST
Mailing Address - Street 2:SUITE 140
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-3156
Mailing Address - Country:US
Mailing Address - Phone:520-745-8424
Mailing Address - Fax:520-298-0760
Practice Address - Street 1:6246 E PIMA ST
Practice Address - Street 2:SUITE 140
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-3156
Practice Address - Country:US
Practice Address - Phone:520-745-8424
Practice Address - Fax:520-298-0760
Is Sole Proprietor?:No
Enumeration Date:2007-10-24
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD32561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ088254OtherAHCCCS