Provider Demographics
NPI:1235275843
Name:MACAJOUX, JEAN RICHARD
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:RICHARD
Last Name:MACAJOUX
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8555 NE 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:EL PORTAL
Mailing Address - State:FL
Mailing Address - Zip Code:33138-3001
Mailing Address - Country:US
Mailing Address - Phone:035-758-5878
Mailing Address - Fax:305-751-7569
Practice Address - Street 1:8555 NE 2ND AVE
Practice Address - Street 2:
Practice Address - City:EL PORTAL
Practice Address - State:FL
Practice Address - Zip Code:33138-3001
Practice Address - Country:US
Practice Address - Phone:035-758-5878
Practice Address - Fax:305-751-7569
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN000141991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice