Provider Demographics
NPI:1689313090
Name:CAPRILES JAQUEZ, MANUEL ARTURO (DDS)
Entity Type:Individual
Prefix:
First Name:MANUEL
Middle Name:ARTURO
Last Name:CAPRILES JAQUEZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2910 NW TREVISO CIR
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-6308
Mailing Address - Country:US
Mailing Address - Phone:909-480-5674
Mailing Address - Fax:
Practice Address - Street 1:1722 SW SAINT LUCIE WEST BLVD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-2504
Practice Address - Country:US
Practice Address - Phone:903-486-5737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-02
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN270481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice