Provider Demographics
NPI:1598487605
Name:PACE, JACQUELINE C (RDH)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:C
Last Name:PACE
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MISS
Other - First Name:JACQUELINE
Other - Middle Name:G
Other - Last Name:CUNNINGHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RDH
Mailing Address - Street 1:P.O. BOX 6071
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23703
Mailing Address - Country:US
Mailing Address - Phone:757-296-3843
Mailing Address - Fax:757-421-7923
Practice Address - Street 1:801 SANDERSON ROAD
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322
Practice Address - Country:US
Practice Address - Phone:757-296-3843
Practice Address - Fax:757-421-7923
Is Sole Proprietor?:No
Enumeration Date:2022-09-15
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0402000925124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist