Provider Demographics
NPI:1548540099
Name:IZQUIERDO, YANEISY (DDS)
Entity type:Individual
Prefix:
First Name:YANEISY
Middle Name:
Last Name:IZQUIERDO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13263 NW 8TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33182-1817
Mailing Address - Country:US
Mailing Address - Phone:786-344-6934
Mailing Address - Fax:
Practice Address - Street 1:13263 NW 8TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33182-1817
Practice Address - Country:US
Practice Address - Phone:786-344-6934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-27
Last Update Date:2011-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN19502122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist