Provider Demographics
NPI:1720369606
Name:JACQUES, TYLER JAMES (DMD)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:JAMES
Last Name:JACQUES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 C ST SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-2002
Mailing Address - Country:US
Mailing Address - Phone:202-543-0700
Mailing Address - Fax:
Practice Address - Street 1:335 C ST SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-2002
Practice Address - Country:US
Practice Address - Phone:202-543-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN10016911223G0001X
IL0190288471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
1891225603OtherORGANIZATIONAL NPI