Provider Demographics
NPI:1407006604
Name:JARQUIN, DORA ELENA (DMD)
Entity Type:Individual
Prefix:DR
First Name:DORA
Middle Name:ELENA
Last Name:JARQUIN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8780 EAST SR 70
Mailing Address - Street 2:SUITE #102
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34202
Mailing Address - Country:US
Mailing Address - Phone:941-345-1100
Mailing Address - Fax:941-345-1099
Practice Address - Street 1:8780 EAST SR 70
Practice Address - Street 2:SUITE #102
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34202
Practice Address - Country:US
Practice Address - Phone:941-345-1100
Practice Address - Fax:941-345-1099
Is Sole Proprietor?:No
Enumeration Date:2008-09-24
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN145941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice