Provider Demographics
NPI:1295017739
Name:VEGA, MARIBELL (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARIBELL
Middle Name:
Last Name:VEGA
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 1:275 HOBART ST
Mailing Address - Street 2:
Mailing Address - City:PERTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08861-3396
Mailing Address - Country:US
Mailing Address - Phone:732-376-9333
Mailing Address - Fax:732-324-7408
Practice Address - Street 1:275 HOBART ST
Practice Address - Street 2:
Practice Address - City:PERTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08861-3396
Practice Address - Country:US
Practice Address - Phone:732-376-9333
Practice Address - Fax:732-324-7408
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-11
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI024819001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice