Provider Demographics
NPI:1639418619
Name:ROBILLARD, JASON DOUGLAS (DMD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:DOUGLAS
Last Name:ROBILLARD
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 1:25 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:MA
Mailing Address - Zip Code:01833-2007
Mailing Address - Country:US
Mailing Address - Phone:978-352-8206
Mailing Address - Fax:978-352-8853
Practice Address - Street 1:25 E MAIN ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:MA
Practice Address - Zip Code:01833-2007
Practice Address - Country:US
Practice Address - Phone:978-352-8206
Practice Address - Fax:978-352-8853
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-11
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN21339122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist