Provider Demographics
NPI:1801372586
Name:SMRECEK, JACLYN ALEXANDRA (DDS)
Entity Type:Individual
Prefix:DR
First Name:JACLYN
Middle Name:ALEXANDRA
Last Name:SMRECEK
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 1:1401 AVOCADO AVE STE 806
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-8706
Mailing Address - Country:US
Mailing Address - Phone:714-308-5687
Mailing Address - Fax:949-759-8609
Practice Address - Street 1:1401 AVOCADO AVE STE 806
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-8706
Practice Address - Country:US
Practice Address - Phone:714-308-5687
Practice Address - Fax:949-759-8609
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-16
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102794122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist