Provider Demographics
NPI:1841965738
Name:JACQUELINE SONCEAU PLLC
Entity type:Organization
Organization Name:JACQUELINE SONCEAU PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:E
Authorized Official - Last Name:HIGHTOWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-226-2525
Mailing Address - Street 1:1610 VAUGHN RD STE J
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27217-2919
Mailing Address - Country:US
Mailing Address - Phone:336-226-2525
Mailing Address - Fax:336-226-0744
Practice Address - Street 1:1610 VAUGHN RD STE J
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27217-2919
Practice Address - Country:US
Practice Address - Phone:336-226-2525
Practice Address - Fax:336-226-0744
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JACQUELINE SONCEAU PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-08-12
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5900643Medicaid