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General NPI Number Information
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NPI Number | 1689313090
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Entity Type | Individual
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Provider Name | MANUEL ARTURO CAPRILES JAQUEZ DDS
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Gender | Male
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Dates
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Enumeration Date | 06/02/2022
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Last Update Date | 03/04/2024
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Provider Practice Location Address
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Address Line | 1722 SW SAINT LUCIE WEST BLVD
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City | PORT ST LUCIE
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State | FL
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Zip | 34986-2504
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Country | US
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Telephone | 903-486-5737
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Fax |
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Provider Business Mailing Address
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Address Line | 2910 NW TREVISO CIR
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City | PORT ST LUCIE
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State | FL
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Zip | 34986-6308
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Country | US
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Telephone | 909-480-5674
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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 | DN27048
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License Number State | FL
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