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General NPI Number Information
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NPI Number | 1619800695
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Entity Type | Organization
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Legal Business Name | YERITZA JAQUEZ DDS PLLC
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Dates
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Enumeration Date | 06/08/2026
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Last Update Date | 06/08/2026
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Provider Practice Location Address
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Address Line | 575 AVENUE K SE
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City | WINTER HAVEN
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State | FL
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Zip | 33880-4215
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Country | US
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Telephone | 863-875-4395
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Fax |
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Provider Business Mailing Address
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Address Line | 10823 SW 62ND TER
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City | MIAMI
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State | FL
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Zip | 33173-1260
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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 | OWNER/DENTIST
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Name | DR. YERITZA JAQUEZ GOMEZ
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Credential | DDS
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Telephone | 786-505-7821
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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