Provider Demographics
NPI:1164551974
Name:VASQUEZ, NORA E (DDS)
Entity Type:Individual
Prefix:DR
First Name:NORA
Middle Name:E
Last Name:VASQUEZ
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 1:6120 GRAND CENTRAL PKWY APT B107
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-1239
Mailing Address - Country:US
Mailing Address - Phone:718-446-5895
Mailing Address - Fax:718-446-1828
Practice Address - Street 1:8916 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-7857
Practice Address - Country:US
Practice Address - Phone:718-446-5895
Practice Address - Fax:718-446-1828
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046530-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE6FMedicaid
NY0016259Medicaid
NY01866191Medicaid