Provider Demographics
NPI:1255823936
Name:SMITH, JESSICA PILLSBURY (DMD)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:PILLSBURY
Last Name:SMITH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2689 N BELFAST AVE
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-0204
Mailing Address - Country:US
Mailing Address - Phone:207-622-0450
Mailing Address - Fax:
Practice Address - Street 1:2689 N BELFAST AVE
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-0204
Practice Address - Country:US
Practice Address - Phone:207-622-0450
Practice Address - Fax:207-622-6387
Is Sole Proprietor?:No
Enumeration Date:2018-05-30
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN46321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice