Individual
DR. BRIAN LEWIS JAQUES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
9200 113TH ST, SEMINOLE, FL 33772-2800
(727) 394-6905
Mailing address
PO BOX 1317, MONCKS CORNER, SC 29461-1317
(843) 899-5911
(843) 899-5968
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
8370
SC
Other
Enumeration date
07/01/2013
Last updated
05/10/2016
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