Provider Demographics
NPI:1942284393
Name:ORDEHI, LICET YAQUELIN
Entity Type:Individual
Prefix:DR
First Name:LICET
Middle Name:YAQUELIN
Last Name:ORDEHI
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:LICET
Other - Middle Name:YAQUELIN
Other - Last Name:ORDEHI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1207 46TH ST
Mailing Address - Street 2:#3
Mailing Address - City:NORTH BERGEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07047-2960
Mailing Address - Country:US
Mailing Address - Phone:201-601-0848
Mailing Address - Fax:201-223-2142
Practice Address - Street 1:901 US HIGHWAY 27 N STE 60
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-2129
Practice Address - Country:US
Practice Address - Phone:863-471-1176
Practice Address - Fax:863-471-2129
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI198581223G0001X
FLDN179051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice