Brian Lewis Jaques, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

8370 Issued in SC

Practice address

9200 113TH St
Seminole, FL 33772-2800

Phone

(727) 394-6905

NPI assigned

Jul 1, 2013

Last updated

May 10, 2016By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in SC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1372636800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1462838400000",
    "number": "1023458379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1317",
            "city": "MONCKS CORNER",
            "state": "SC",
            "postal_code": "294611317",
            "telephone_number": "843-899-5911",
            "fax_number": "843-899-5968"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9200 113TH ST",
            "city": "SEMINOLE",
            "state": "FL",
            "postal_code": "337722800",
            "telephone_number": "727-394-6905"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JAQUES",
        "first_name": "BRIAN",
        "middle_name": "LEWIS",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-07-01",
        "last_updated": "2016-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "SC",
            "license": "8370",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• James R Johnson DO PA
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• Robert J Jenkins
• Jenna Godwin LLC
• Regla Jimenez Reyes
• Jessica Corin Jimenez, PT, DPT
• Jennifer Henkel Johnson, D.M.D.

• General Practice Dentistry in Seminole, FL
• Providers in Seminole, FL by specialty
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.