Richard Glenn Jacques, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

02333 Issued in SC

Practice address

16 Mills Ave
Unit #1
Greenville, SC 29605-4070

Phone

(864) 242-4848

NPI assigned

Feb 15, 2007

Sex

Male

Sole proprietor

No

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": "1171497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1455494400000",
    "number": "1164566105",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16 MILLS AVE",
            "address_2": "STE 1",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296054065",
            "telephone_number": "864-242-4848"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16 MILLS AVE",
            "address_2": "UNIT #1",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296054070",
            "telephone_number": "864-242-4848"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACQUES",
        "first_name": "RICHARD",
        "middle_name": "GLENN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-15",
        "last_updated": "2016-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "SC",
            "license": "02333",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leigh Kristin Jacobson, DPT
• Andrea L Jacoby, M.A., CCC-SLP
• Daniel Mark Jacques, MD
• Denise M Jacques, M.D.
• Margaret Lauren Jacques, D.M.D.
• Cathy A Jaggars
• Harshita Jain
• Sandip Jain, MD
• Vina Bhatt Jain, M.D.
• Derek Prainorut Jakes, M.D.

• Dentist in Greenville, SC
• Providers in Greenville, SC by specialty
• Dentist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 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.