Provider Demographics
NPI:1497894943
Name:JACQUE V LEBEAU DMD
Entity Type:Organization
Organization Name:JACQUE V LEBEAU DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUE
Authorized Official - Middle Name:VICTOR
Authorized Official - Last Name:LEBEAU
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:850-434-1964
Mailing Address - Street 1:1401 N PALAFOX ST
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32501-2642
Mailing Address - Country:US
Mailing Address - Phone:850-434-1964
Mailing Address - Fax:
Practice Address - Street 1:1401 N PALAFOX ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-2642
Practice Address - Country:US
Practice Address - Phone:850-434-1964
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6878122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty