Provider Demographics
NPI:1962121384
Name:CECIL, JACQULINE DANIELLE (DMD)
Entity type:Individual
Prefix:
First Name:JACQULINE
Middle Name:DANIELLE
Last Name:CECIL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:JACQULINE
Other - Middle Name:
Other - Last Name:CECIL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:146 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-9495
Mailing Address - Country:US
Mailing Address - Phone:859-588-2599
Mailing Address - Fax:
Practice Address - Street 1:101 QUAIL DR
Practice Address - Street 2:
Practice Address - City:CYNTHIANA
Practice Address - State:KY
Practice Address - Zip Code:41031-9482
Practice Address - Country:US
Practice Address - Phone:859-588-2599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY108451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice