Provider Demographics
NPI:1326244757
Name:JAQUES, CARY (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARY
Middle Name:
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 1:300 WEST A STREET
Mailing Address - Street 2:
Mailing Address - City:FALLON
Mailing Address - State:NV
Mailing Address - Zip Code:89406
Mailing Address - Country:US
Mailing Address - Phone:775-423-5213
Mailing Address - Fax:775-423-9602
Practice Address - Street 1:300 WEST A STREET
Practice Address - Street 2:
Practice Address - City:FALLON
Practice Address - State:NV
Practice Address - Zip Code:89406
Practice Address - Country:US
Practice Address - Phone:775-423-5213
Practice Address - Fax:775-423-9602
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-22
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014118141223G0001X
NV58941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice