Provider Demographics
NPI:1497948897
Name:HANKS, JACQUELINE RENEE (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:RENEE
Last Name:HANKS
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Gender:F
Credentials:DDS, MSD
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Mailing Address - Street 1:26711 ALISO CREEK RD
Mailing Address - Street 2:SUITE 200C
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-4820
Mailing Address - Country:US
Mailing Address - Phone:949-480-1202
Mailing Address - Fax:949-940-8699
Practice Address - Street 1:26711 ALISO CREEK RD
Practice Address - Street 2:SUITE 200C
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-4820
Practice Address - Country:US
Practice Address - Phone:949-480-1202
Practice Address - Fax:949-940-8699
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA418061223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics