Provider Demographics
NPI:1215371729
Name:JAQUES, WILLIAM CLARENCE (DDS,)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:CLARENCE
Last Name:JAQUES
Suffix:
Gender:M
Credentials:DDS,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6805 QUAIL HILL PKWY
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92603-4234
Mailing Address - Country:US
Mailing Address - Phone:949-823-0006
Mailing Address - Fax:
Practice Address - Street 1:6805 QUAIL HILL PKWY
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92603-4234
Practice Address - Country:US
Practice Address - Phone:949-823-0006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-26
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA190971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice