Provider Demographics
NPI:1245799741
Name:VASQUEZ, IVONNE MARITZA (DDS)
Entity Type:Individual
Prefix:
First Name:IVONNE
Middle Name:MARITZA
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 1:3350 WATER OAK DR
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-8430
Mailing Address - Country:US
Mailing Address - Phone:954-993-5615
Mailing Address - Fax:
Practice Address - Street 1:3350 WATER OAK DR
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-8430
Practice Address - Country:US
Practice Address - Phone:954-993-5615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-14
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN26218122300000X
FLDRPM1994390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes122300000XDental ProvidersDentist