Provider Demographics
NPI:1003885401
Name:VAZQUEZ, HUMBERTO (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:HUMBERTO
Middle Name:
Last Name:VAZQUEZ
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 406
Mailing Address - Street 2:
Mailing Address - City:GUANICA
Mailing Address - State:PR
Mailing Address - Zip Code:00653-0406
Mailing Address - Country:US
Mailing Address - Phone:787-841-5515
Mailing Address - Fax:787-841-5515
Practice Address - Street 1:URB MARIANI 1577 -MUNOZ RIVERA AVE.
Practice Address - Street 2:SUITE 2
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-0211
Practice Address - Country:US
Practice Address - Phone:787-840-5515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11661223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR41186OtherTRIPLE S, INC.