Provider Demographics
NPI:1043404411
Name:VAZQUEZ, MARIA A (DDS)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:A
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45975 FARGO ST STE 1
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-4587
Mailing Address - Country:US
Mailing Address - Phone:760-775-3368
Mailing Address - Fax:
Practice Address - Street 1:45975 FARGO ST STE 1
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-4587
Practice Address - Country:US
Practice Address - Phone:760-775-3368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4427301122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB4427301OtherDENTICAL