MEDICARE: DR. JACQUELINE MARIE HASSENPLUG DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	019.033300	IL

General Provider Information

NPI Number	:	1508438185
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACQUELINE MARIE HASSENPLUG DMD

Provider Business Mailing Address
First Line	:	338 CLARE DR
Second Line	:
City	:	BLOOMINGDALE
State	:	IL
Zip	:	60108-8809
Country	:	US
Telephone Number	:	630-743-9086
Fax Number	:

Provider Business Practice Location Address
First Line	:	603 E IRVING PARK RD
Second Line	:
City	:	ROSELLE
State	:	IL
Zip	:	60172-2302
Country	:	US
Telephone Number	:	630-893-4200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2021
Last Update Date	:	07/13/2021

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