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General NPI Number Information
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NPI Number | 1548681885
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Entity Type | Organization
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Legal Business Name | DEQUEEN DENTAL
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Dates
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Enumeration Date | 01/03/2014
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Last Update Date | 01/03/2014
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Provider Practice Location Address
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Address Line | 1347 W COLLIN RAYE DR
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City | DE QUEEN
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State | AR
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Zip | 71832-2946
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Country | US
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Telephone | 870-642-5034
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Fax | 870-642-2365
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Provider Business Mailing Address
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Address Line | 1347 W COLLIN RAYE DR
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City | DE QUEEN
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State | AR
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Zip | 71832-2946
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Country | US
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Telephone | 870-642-5034
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Fax | 870-642-2365
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. CHRISTIE JAQUESS
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Credential | D.D.S.
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Telephone | 870-642-5034
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 3669
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License Number State | AR
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