Provider Demographics
NPI:1992955124
Name:EXPOSITO, JACQUES PHILIPPE (DDS)
Entity type:Individual
Prefix:MR
First Name:JACQUES
Middle Name:PHILIPPE
Last Name:EXPOSITO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1404 CRAIN HWY STE #110
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-4056
Mailing Address - Country:US
Mailing Address - Phone:410-768-8220
Mailing Address - Fax:410-768-8252
Practice Address - Street 1:1404 CRAIN HWY STE #110
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-4056
Practice Address - Country:US
Practice Address - Phone:410-768-8220
Practice Address - Fax:410-768-8252
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-24
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12223122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist