Provider Demographics
NPI:1649613597
Name:DR. DENIS JACQUES DDS PC
Entity type:Organization
Organization Name:DR. DENIS JACQUES DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DENIS
Authorized Official - Middle Name:ARMAND
Authorized Official - Last Name:JACQUES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:570-654-2484
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-10
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty