Individual
DR. JEREMIAH EDILLOR JUSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
2301 QUEENS PLZ N STE C, LONG ISLAND CITY, NY 11101
(508) 679-8111
Mailing address
360 E 89TH ST APT 5B, NEW YORK, NY 10128-5418
(212) 803-3345
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
DL11820
MA
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
059613
NY
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
DL11820
MA
Other
Enumeration date
09/22/2009
Last updated
03/07/2023
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