Provider Demographics
NPI:1134181035
Name:SONCEAU, JACQUELINE B (DDS)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:B
Last Name:SONCEAU
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 1:2482 WONDER DR
Mailing Address - Street 2:
Mailing Address - City:KANNAPOLIS
Mailing Address - State:NC
Mailing Address - Zip Code:28083-6427
Mailing Address - Country:US
Mailing Address - Phone:704-786-7007
Mailing Address - Fax:704-786-7006
Practice Address - Street 1:2482 WONDER DR
Practice Address - Street 2:
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28083-6427
Practice Address - Country:US
Practice Address - Phone:704-786-7007
Practice Address - Fax:704-786-7006
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4056122300000X
NC83061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC2X4056Medicaid
NC5900643Medicaid