Provider Demographics
NPI:1376625939
Name:JACQUES, MICHAEL JOSEPH (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:JACQUES
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 1:16000 PARK VALLEY DR STE 100
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-4009
Mailing Address - Country:US
Mailing Address - Phone:512-244-7995
Mailing Address - Fax:512-310-0451
Practice Address - Street 1:16000 PARK VALLEY DR STE 100
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4009
Practice Address - Country:US
Practice Address - Phone:512-244-7995
Practice Address - Fax:512-310-0451
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX238441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice