Healthcare Provider Details

I. General information

NPI: 1619800695
Provider Name (Legal Business Name): YERITZA JAQUEZ DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 AVENUE K SE
WINTER HAVEN FL
33880-4215
US

IV. Provider business mailing address

10823 SW 62ND TER
MIAMI FL
33173-1260
US

V. Phone/Fax

Practice location:
  • Phone: 863-875-4395
  • Fax:
Mailing address:
  • Phone:
  • 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. YERITZA JAQUEZ GOMEZ
Title or Position: OWNER/DENTIST
Credential: DDS
Phone: 786-505-7821