Provider Demographics
NPI:1144331570
Name:JAQUES, RONALD WILLIAM (DDS)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:WILLIAM
Last Name:JAQUES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5031 S FEDERAL BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80110-6368
Mailing Address - Country:US
Mailing Address - Phone:303-795-3517
Mailing Address - Fax:303-703-9651
Practice Address - Street 1:5031 S FEDERAL BLVD STE 4
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80110-6368
Practice Address - Country:US
Practice Address - Phone:303-795-3517
Practice Address - Fax:303-703-9651
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO375122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO02003754Medicaid