Provider Demographics
NPI:1851777106
Name:VINEYARD, JACQUELINE (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:
Last Name:VINEYARD
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:DR
Other - First Name:JACQUELINE
Other - Middle Name:
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD, MS
Mailing Address - Street 1:515 1ST AVE S
Mailing Address - Street 2:
Mailing Address - City:TIERRA VERDE
Mailing Address - State:FL
Mailing Address - Zip Code:33715-2236
Mailing Address - Country:US
Mailing Address - Phone:727-410-5985
Mailing Address - Fax:
Practice Address - Street 1:515 1ST AVE S
Practice Address - Street 2:
Practice Address - City:TIERRA VERDE
Practice Address - State:FL
Practice Address - Zip Code:33715-2236
Practice Address - Country:US
Practice Address - Phone:727-410-5985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-09
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN212901223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics