Provider Demographics
NPI:1407005390
Name:VASQUEZ, JASON JOHN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:JOHN
Last Name:VASQUEZ
Suffix:
Gender:M
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:P.O. BOX 9460
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78469
Mailing Address - Country:US
Mailing Address - Phone:361-331-2557
Mailing Address - Fax:361-299-7778
Practice Address - Street 1:501 NUECES BAY BLVD.
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78408
Practice Address - Country:US
Practice Address - Phone:361-331-2557
Practice Address - Fax:361-299-7778
Is Sole Proprietor?:No
Enumeration Date:2008-09-16
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23422122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist