Provider Demographics
NPI:1598114597
Name:SCHWARTZ, JACLYN (DMD)
Entity Type:Individual
Prefix:DR
First Name:JACLYN
Middle Name:
Last Name:SCHWARTZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 E WETMORE RD
Mailing Address - Street 2:STE 117 - 206
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85705-1717
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3773 W INA RD
Practice Address - Street 2:#180
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-2246
Practice Address - Country:US
Practice Address - Phone:520-579-8166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-09
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0094841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice