Provider Demographics
NPI:1033771597
Name:PABON-VAZQUEZ, ELIAS KEMUEL
Entity Type:Individual
Prefix:
First Name:ELIAS
Middle Name:KEMUEL
Last Name:PABON-VAZQUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 MANNING DR
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-4220
Mailing Address - Country:US
Mailing Address - Phone:984-974-1485
Mailing Address - Fax:984-974-0355
Practice Address - Street 1:229 CALLE DUARTE STE 4A
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-3631
Practice Address - Country:US
Practice Address - Phone:787-945-5077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-05
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC512511223G0001X
NC117031223G0001X
PR34411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice