Healthcare Provider Details

I. General information

NPI: 1942284393
Provider Name (Legal Business Name): DR. LICET YAQUELIN ORDEHI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LICET YAQUELIN ORDEHI DDS

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 03/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 US HIGHWAY 27 N STE 60
SEBRING FL
33870-2129
US

IV. Provider business mailing address

1207 46TH ST #3
NORTH BERGEN NJ
07047-2960
US

V. Phone/Fax

Practice location:
  • Phone: 863-471-1176
  • Fax: 863-471-2129
Mailing address:
  • Phone: 201-601-0848
  • Fax: 201-223-2142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDI19858
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN17905
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: