Provider Demographics
NPI:1235821919
Name:VEGA, YANIRE FABIOLA (DMD)
Entity Type:Individual
Prefix:
First Name:YANIRE
Middle Name:FABIOLA
Last Name:VEGA
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 1:14425 W MCDOWELL RD STE F106
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-2516
Mailing Address - Country:US
Mailing Address - Phone:623-257-7333
Mailing Address - Fax:
Practice Address - Street 1:14425 W MCDOWELL RD STE F106
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-2516
Practice Address - Country:US
Practice Address - Phone:623-257-7333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-22
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0117781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice