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General NPI Number Information
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NPI Number | 1225902430
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Entity Type | Individual
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Provider Name | JACQUELINE ROSE MANCILLAS
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Gender | Female
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Dates
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Enumeration Date | 10/01/2025
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Last Update Date | 10/01/2025
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Provider Practice Location Address
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Address Line | 36065 SANTA FE AVE
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City | FORT HOOD
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State | TX
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Zip | 76544-5060
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Country | US
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Telephone | 254-288-8888
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Fax |
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Provider Business Mailing Address
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Address Line | 1103 CARLSBERG DR APT A
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City | KILLEEN
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State | TX
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Zip | 76549-7298
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Country | US
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Telephone | 775-512-9111
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number |
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License Number State |
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