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General NPI Number Information
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NPI Number | 1902938046
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Entity Type | Individual
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Provider Name | JACQUELYN DO DDS
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Gender | Female
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Dates
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Enumeration Date | 03/12/2007
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Last Update Date | 09/16/2009
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Provider Practice Location Address
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Address Line | 3525 BROADWAY STREET SUITE 101
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City | PEARLAND
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State | TX
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Zip | 77581
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Country | US
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Telephone | 281-485-1133
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Fax | 281-485-1166
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Provider Business Mailing Address
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Address Line | 3525 BROADWAY STREET SUITE 101
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City | PEARLAND
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State | TX
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Zip | 77581
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Country | US
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Telephone | 281-485-1133
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Fax | 281-485-1166
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 0023838
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 53206
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D53206
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 23838
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License Number State | TX
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