Provider Demographics
NPI:1003933672
Name:VAZQUEZ, GEORGE A (DMD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:A
Last Name:VAZQUEZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 SW 128TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-5442
Mailing Address - Country:US
Mailing Address - Phone:305-245-0304
Mailing Address - Fax:
Practice Address - Street 1:8950 SW 74TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-3171
Practice Address - Country:US
Practice Address - Phone:305-245-0304
Practice Address - Fax:305-245-0306
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL168701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice