Provider Demographics
NPI:1083878896
Name:DAGUE, JOLENE MARIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOLENE
Middle Name:MARIE
Last Name:DAGUE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:JOLENE
Other - Middle Name:MARIE
Other - Last Name:HERMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1905 N. MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52803
Mailing Address - Country:US
Mailing Address - Phone:563-323-2571
Mailing Address - Fax:
Practice Address - Street 1:1905 N. MAIN ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52803
Practice Address - Country:US
Practice Address - Phone:563-323-2571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-11
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA085421223G0001X
IADDS-085421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice