Provider Demographics
NPI:1013035948
Name:ARGANDONA-DAAB, JACKELINE AUDREY (DMD)
Entity Type:Individual
Prefix:DR
First Name:JACKELINE
Middle Name:AUDREY
Last Name:ARGANDONA-DAAB
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 GREENLEAF AVE SUITE E
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60085
Mailing Address - Country:US
Mailing Address - Phone:847-249-5700
Mailing Address - Fax:847-249-5714
Practice Address - Street 1:2906 S BAGDAD RD STE 100
Practice Address - Street 2:
Practice Address - City:LEANDER
Practice Address - State:TX
Practice Address - Zip Code:78641-3269
Practice Address - Country:US
Practice Address - Phone:512-259-1250
Practice Address - Fax:512-259-1160
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX305451223G0001X
NH32511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAZ81744OtherBLUE CROSS
000796847OtherUNITED CONCORDIA