Provider Demographics
NPI:1194342543
Name:CEJAS DOMINGUEZ, YANET (DMD)
Entity type:Individual
Prefix:
First Name:YANET
Middle Name:
Last Name:CEJAS DOMINGUEZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11697 NW 2ND ST APT 204
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-4955
Mailing Address - Country:US
Mailing Address - Phone:305-795-0456
Mailing Address - Fax:
Practice Address - Street 1:11697 NW 2ND ST APT 204
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-4955
Practice Address - Country:US
Practice Address - Phone:305-795-0456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-01
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN24984122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist