Provider Demographics
NPI:1518501444
Name:JAQUERY DENTAL INC.
Entity Type:Organization
Organization Name:JAQUERY DENTAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:VINICIUS
Authorized Official - Middle Name:A
Authorized Official - Last Name:JAQUERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-722-8469
Mailing Address - Street 1:56 PENNY LN STE C
Mailing Address - Street 2:
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-6018
Mailing Address - Country:US
Mailing Address - Phone:831-722-8469
Mailing Address - Fax:831-722-0241
Practice Address - Street 1:56 PENNY LN STE C
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-6018
Practice Address - Country:US
Practice Address - Phone:831-722-8469
Practice Address - Fax:831-722-0241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-04
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
1558550954OtherNPPES