Provider Demographics
NPI:1558550954
Name:JAQUERY, ALEXANDRA E (DDS)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:E
Last Name:JAQUERY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 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
Is Sole Proprietor?:No
Enumeration Date:2007-10-22
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901019713122300000X
CA64257122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist