Organization
TYLER J JACQUES PLLC
Active
Other names
Capitol Family Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
TYLER J JACQUES (REGISTERED AGENT)
(989) 980-2807
Entity
Organization
Contact information
Practice address
335 C ST SE, WASHINGTON, DC 20003-2002
(989) 980-2807
Mailing address
335 C ST SE, WASHINGTON, DC 20003
(202) 543-0700
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DEN1001691
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1720369606
INDIVIDUAL NPI
—
Enumeration date
06/14/2017
Last updated
09/18/2017
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