Healthcare Provider Details

I. General information

NPI: 1881518736
Provider Name (Legal Business Name): DR. JULIETTE SUZANNE DEFANT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JULIETTE SUZANNE WERTZ

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18434 HANCOCK BLUFF RD
DADE CITY FL
33523-1928
US

IV. Provider business mailing address

18434 HANCOCK BLUFF RD
DADE CITY FL
33523-1928
US

V. Phone/Fax

Practice location:
  • Phone: 813-519-2505
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN31890
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: