Provider Demographics
NPI:1235335688
Name:GEORGE A. VAZQUEZ DMD PA
Entity Type:Organization
Organization Name:GEORGE A. VAZQUEZ DMD PA
Other - Org Name:DENTAL OF HOMESTEAD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:A
Authorized Official - Last Name:VAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:305-246-9343
Mailing Address - Street 1:2040 NE 8TH ST
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-4702
Mailing Address - Country:US
Mailing Address - Phone:305-245-9343
Mailing Address - Fax:305-245-9393
Practice Address - Street 1:2040 NE 8TH ST
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-4702
Practice Address - Country:US
Practice Address - Phone:305-245-9343
Practice Address - Fax:305-245-9393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 16870261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental