Provider Demographics
NPI:1346552270
Name:JACQUES, MARGARET LAUREN (DMD)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:LAUREN
Last Name:JACQUES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 MILLS AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-4065
Mailing Address - Country:US
Mailing Address - Phone:864-242-4848
Mailing Address - Fax:
Practice Address - Street 1:16 MILLS AVE STE 1
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4065
Practice Address - Country:US
Practice Address - Phone:864-242-4848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-08
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6902122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZX6902Medicaid