Provider Demographics
NPI:1205900545
Name:JACQUES, DENIS ARMAND (DDS)
Entity type:Individual
Prefix:DR
First Name:DENIS
Middle Name:ARMAND
Last Name:JACQUES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 SOUTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:PITTSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18640
Mailing Address - Country:US
Mailing Address - Phone:570-654-2484
Mailing Address - Fax:570-654-4867
Practice Address - Street 1:34 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:PITTSTON
Practice Address - State:PA
Practice Address - Zip Code:18640
Practice Address - Country:US
Practice Address - Phone:570-654-2484
Practice Address - Fax:570-654-4867
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS020524L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA75866OtherMED PLUS
PA0006496590001Medicaid
PA151009OtherUNITED CONCORDIA