Active NPI
Denis Armand Jacques, DDS
- Dentist
- Pittston, PA
National Provider Identifier
1205900545
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DS020524L
- Practice address
- 34 South Main Street
Pittston, PA 18640 - Phone
- (570) 654-2484
- Fax
- (570) 654-4867
- NPI assigned
- Nov 20, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DS020524L | PA | Primary |
Addresses
Primary practice location
34 South Main Street
Pittston, PA 18640
Mailing address
34 South Main Street
Pittston, PA 18640
Phone (570) 654-2484
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 75866 | Other | PA | MED PLUS |
| 0006496590001 | Medicaid | PA | |
| 151009 | Other | PA | UNITED CONCORDIA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DS020524L | PA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163980800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1205900545",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "34 SOUTH MAIN STREET",
"city": "PITTSTON",
"state": "PA",
"postal_code": "18640",
"telephone_number": "570-654-2484",
"fax_number": "570-654-4867"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "34 SOUTH MAIN STREET",
"city": "PITTSTON",
"state": "PA",
"postal_code": "18640",
"telephone_number": "570-654-2484",
"fax_number": "570-654-4867"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACQUES",
"first_name": "DENIS",
"middle_name": "ARMAND",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "PA",
"license": "DS020524L",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MED PLUS",
"identifier": "75866",
"state": "PA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0006496590001",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED CONCORDIA",
"identifier": "151009",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pittston, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.