Provider Demographics
NPI:1649495417
Name:JACQUES, LIONEL M (DDS)
Entity type:Individual
Prefix:DR
First Name:LIONEL
Middle Name:M
Last Name:JACQUES
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 1:427 W 20TH ST
Mailing Address - Street 2:SUITE 702
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-2441
Mailing Address - Country:US
Mailing Address - Phone:713-868-2721
Mailing Address - Fax:713-862-1199
Practice Address - Street 1:427 W 20TH ST
Practice Address - Street 2:SUITE 702
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-2441
Practice Address - Country:US
Practice Address - Phone:713-868-2721
Practice Address - Fax:713-862-1199
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice