Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 12113 | NC |
Y | 1223D0001X | Dental Public Health | 12113 | NC |
N | 1223G0001X | General Practice | DEN.00204329 | CO |
N | 213EG0000X | General Practice | DEN.00204329 | CO |
NPI | 1457985004 |
---|---|
Provider Name | Dr. Jillian Dubuisson |
First Address | Jefferson, NC 28640 |
Second Address | Jefferson, NC 28640 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2020 |
Last Update Date | 06/10/2021 |