Healthcare Provider Details

I. General information

NPI: 1114859014
Provider Name (Legal Business Name): JAICKS DMD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 MAGNOLIA DR
ALTAMONTE SPRINGS FL
32701-5705
US

IV. Provider business mailing address

2941 ECON LANDING BLVD
ORLANDO FL
32825-7862
US

V. Phone/Fax

Practice location:
  • Phone: 407-767-0633
  • Fax:
Mailing address:
  • Phone: 614-257-7324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN JAICKS
Title or Position: PRESIDENT
Credential: DMD
Phone: 614-257-7324