Provider Demographics
NPI:1174579080
Name:JEFFREY H DUBOIS DDS PC
Entity type:Organization
Organization Name:JEFFREY H DUBOIS DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:H
Authorized Official - Last Name:DUBOIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:520-745-8424
Mailing Address - Street 1:6246 E PIMA ST
Mailing Address - Street 2:STE 140
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-3157
Mailing Address - Country:US
Mailing Address - Phone:520-745-8424
Mailing Address - Fax:520-298-0760
Practice Address - Street 1:6246 E PIMA ST
Practice Address - Street 2:STE 140
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-3157
Practice Address - Country:US
Practice Address - Phone:520-745-8424
Practice Address - Fax:520-298-0760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD32561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ088254OtherAHCCCS