Provider Demographics
NPI:1407615040
Name:DENTAMICI PLLC
Entity Type:Organization
Organization Name:DENTAMICI PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:VAZQUEZ DDS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:469-278-8747
Mailing Address - Street 1:8050 FALL RIVER DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75228-5915
Mailing Address - Country:US
Mailing Address - Phone:469-278-8747
Mailing Address - Fax:
Practice Address - Street 1:925 N BRYAN BELT LINE RD
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-2541
Practice Address - Country:US
Practice Address - Phone:469-278-8747
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty