Provider Demographics
NPI:1124032099
Name:DR JEFFREY R DORNBUSH PSS PC
Entity type:Organization
Organization Name:DR JEFFREY R DORNBUSH PSS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:R
Authorized Official - Last Name:DORNBUSH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS PC
Authorized Official - Phone:781-639-0700
Mailing Address - Street 1:210 HUMPHREY STREET
Mailing Address - Street 2:
Mailing Address - City:MARBLEHEAD
Mailing Address - State:MA
Mailing Address - Zip Code:01945
Mailing Address - Country:US
Mailing Address - Phone:781-639-0700
Mailing Address - Fax:781-639-8060
Practice Address - Street 1:210 HUMPHREY STREET
Practice Address - Street 2:
Practice Address - City:MARBLEHEAD
Practice Address - State:MA
Practice Address - Zip Code:01945
Practice Address - Country:US
Practice Address - Phone:781-639-0700
Practice Address - Fax:781-639-8060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA133021223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty