Provider Demographics
NPI:1598141574
Name:PRAPTA, JACLYN ANGELIQUE (DDS)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:ANGELIQUE
Last Name:PRAPTA
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:PO BOX 860036
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55486-0036
Mailing Address - Country:US
Mailing Address - Phone:855-864-1995
Mailing Address - Fax:
Practice Address - Street 1:9825 S MASON RD
Practice Address - Street 2:SUITE 120
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77406-5810
Practice Address - Country:US
Practice Address - Phone:855-864-1995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-03
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX312191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice