Provider Demographics
NPI:1457985004
Name:DUBUISSON, JILLIAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:JILLIAN
Middle Name:
Last Name:DUBUISSON
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 1:225 COURT ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:NC
Mailing Address - Zip Code:28640
Mailing Address - Country:US
Mailing Address - Phone:781-217-4260
Mailing Address - Fax:
Practice Address - Street 1:225 COURT ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:NC
Practice Address - Zip Code:28640
Practice Address - Country:US
Practice Address - Phone:336-246-9449
Practice Address - Fax:336-846-1910
Is Sole Proprietor?:No
Enumeration Date:2020-02-22
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12113122300000X, 1223D0001X
CODEN.002043291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
No122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice