Provider Demographics
NPI:1184851503
Name:FAUST, JACQUELINE RUTH (DDS)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:RUTH
Last Name:FAUST
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3008 20TH ST STE H
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-4900
Mailing Address - Country:US
Mailing Address - Phone:504-834-1993
Mailing Address - Fax:504-834-1620
Practice Address - Street 1:3008 20TH ST STE H
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-4900
Practice Address - Country:US
Practice Address - Phone:504-834-1993
Practice Address - Fax:504-834-1620
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-11
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA59641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice