Provider Demographics
NPI:1891225603
Name:TYLER J JACQUES PLLC
Entity Type:Organization
Organization Name:TYLER J JACQUES PLLC
Other - Org Name:CAPITOL FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGISTERED AGENT
Authorized Official - Prefix:
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:J
Authorized Official - Last Name:JACQUES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-980-2807
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
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:989-980-2807
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-14
Last Update Date:2017-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN1001691122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1720369606OtherINDIVIDUAL NPI