Individual
JAQUERIA BRIANNA LACY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
2066 NC HIGHWAY 125 # 603, ROANOKE RAPIDS, NC 27870-9436
(863) 279-2887
Mailing address
99 KNEELAND ST APT 603, BOSTON, MA 02111-2436
(863) 279-2887
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
NC
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
03/27/2025
Last updated
05/19/2026
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