Provider Demographics
NPI:1518081959
Name:JAECKLE, HUGO MICHAEL III (DDS)
Entity Type:Individual
Prefix:DR
First Name:HUGO
Middle Name:MICHAEL
Last Name:JAECKLE
Suffix:III
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 1:515 W BEAUREGARD AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76903-6360
Mailing Address - Country:US
Mailing Address - Phone:325-655-0663
Mailing Address - Fax:325-655-0665
Practice Address - Street 1:515 W BEAUREGARD AVE
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76903-6360
Practice Address - Country:US
Practice Address - Phone:325-655-0663
Practice Address - Fax:325-655-0665
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX142011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice