Provider Demographics
NPI:1154037018
Name:ERIGUEL, JACQUELINE YOUNG (DMD)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:YOUNG
Last Name:ERIGUEL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2155 N ELSTON AVE APT 218
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-0048
Mailing Address - Country:US
Mailing Address - Phone:347-538-5619
Mailing Address - Fax:
Practice Address - Street 1:2155 N ELSTON AVE APT 218
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-0048
Practice Address - Country:US
Practice Address - Phone:347-538-5619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-24
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019034005122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist