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General NPI Number Information
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NPI Number | 1336767029
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Entity Type | Individual
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Provider Name | JACQUELINE YIP DMD
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Gender | Female
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Dates
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Enumeration Date | 07/08/2020
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Last Update Date | 07/19/2023
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Provider Practice Location Address
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Address Line | 391 N CONGRESS AVE
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City | BOYNTON BEACH
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State | FL
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Zip | 33426-3415
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Country | US
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Telephone | 561-336-6560
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Fax |
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Provider Business Mailing Address
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Address Line | 22714 ASPECT DR APT 301
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City | BOCA RATON
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State | FL
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Zip | 33428-3659
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DS042800
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 0442000420
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DN27688
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License Number State | FL
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