Provider Demographics
NPI:1821277583
Name:HELGESON, JACQUELINE R (DDS)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:R
Last Name:HELGESON
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 1:3119 GOLF RD
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-7006
Mailing Address - Country:US
Mailing Address - Phone:715-834-5882
Mailing Address - Fax:715-834-1988
Practice Address - Street 1:3119 GOLF RD
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-7006
Practice Address - Country:US
Practice Address - Phone:715-834-5882
Practice Address - Fax:715-834-1988
Is Sole Proprietor?:No
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1892G1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice