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General NPI Number Information
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NPI Number | 1609156025
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Entity Type | Individual
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Provider Name | JACLYNE IVETTE HERRERA DMD
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Gender | Female
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Dates
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Enumeration Date | 08/17/2011
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Last Update Date | 09/27/2021
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Provider Practice Location Address
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Address Line | 8438 SW 103RD STREET RD
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City | OCALA
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State | FL
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Zip | 34481-7766
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Country | US
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Telephone | 352-237-3343
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Fax | 352-861-1091
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Provider Business Mailing Address
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Address Line | 3721 SW 51ST TER
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City | OCALA
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State | FL
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Zip | 34474-9408
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Country | US
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Telephone | 337-353-9850
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DN19459
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License Number State | FL
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