Provider Demographics
NPI:1609156025
Name:HERRERA, JACLYNE IVETTE (DMD)
Entity Type:Individual
Prefix:DR
First Name:JACLYNE
Middle Name:IVETTE
Last Name:HERRERA
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 1:3721 SW 51ST TER
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-9408
Mailing Address - Country:US
Mailing Address - Phone:337-353-9850
Mailing Address - Fax:
Practice Address - Street 1:8438 SW 103RD STREET RD
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34481-7766
Practice Address - Country:US
Practice Address - Phone:352-237-3343
Practice Address - Fax:352-861-1091
Is Sole Proprietor?:No
Enumeration Date:2011-08-17
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN19459122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist