Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Jillisa Boller, DENTALASSISTANTX2

Individual provider Dental Assistant · NPI 1750730446

Jillisa Boller, DENTALASSISTANTX2 is a Dental Assistant in Fort Drum, New York. Practices as a sole proprietor. Registered with an NPI since 2016.

In the registry since
2016
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Practice location Address checks out

10590 Enduring Freedom Dr
Fort Drum, NY 13602-5005
Phone: (315) 772-6234
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dental Assistant (primary) Taxonomy 126800000X

Record details

NPI number1750730446
Entity typeIndividual (Type 1)
GenderFemale
Credentials DENTALASSISTANTX2
Sole proprietorYes
NPI enumeratedJune 3, 2016
Last updated in NPPESJune 3, 2016

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