Provider Demographics
NPI:1750576948
Name:BUSSEY, JILL (DMD, PC)
Entity type:Individual
Prefix:DR
First Name:JILL
Middle Name:
Last Name:BUSSEY
Suffix:
Gender:F
Credentials:DMD, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 W LEIGH ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220-3200
Mailing Address - Country:US
Mailing Address - Phone:804-644-5225
Mailing Address - Fax:804-644-5421
Practice Address - Street 1:505 W LEIGH ST
Practice Address - Street 2:SUITE 204
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220-3200
Practice Address - Country:US
Practice Address - Phone:804-644-5225
Practice Address - Fax:804-644-5421
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401007197122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
846274OtherUNITED CONCORDIA
266086OtherANTHEM