Basic Information
| Provider Information | |||||||||
| NPI: | 1811368111 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | YANEZ | ||||||||
| FirstName: | DANIELA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2601 10TH AVE N | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | PALM SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334613141 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5616421008 | ||||||||
| FaxNumber: | 5618023976 | ||||||||
| Practice Location | |||||||||
| Address1: | 225 S CONGRESS AVE | ||||||||
| Address2: | |||||||||
| City: | DELRAY BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334454616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5613701303 | ||||||||
| FaxNumber: | 5612438777 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2015 | ||||||||
| LastUpdateDate: | 10/13/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 124Q00000X | DH19407 | ZZ | Y | Dental Providers | Dental Hygienist |
ID Information
| ID | Type | State | Issuer | Description | DH19407 | 01 | FL | FL LICENSE | OTHER |