Provider Demographics
NPI:1063671980
Name:VEGA-PAZ, EYDA (DMD)
Entity Type:Individual
Prefix:
First Name:EYDA
Middle Name:
Last Name:VEGA-PAZ
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 1:12473 SW 77TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-3542
Mailing Address - Country:US
Mailing Address - Phone:305-388-7676
Mailing Address - Fax:305-388-7919
Practice Address - Street 1:13045 SW 112TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4601
Practice Address - Country:US
Practice Address - Phone:305-388-7676
Practice Address - Fax:305-388-7919
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN15757122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist