Provider Demographics
NPI:1417163718
Name:VAZQUEZ, JORGE EMILIO (DMD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:EMILIO
Last Name:VAZQUEZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:636 BLUE RD
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-1726
Mailing Address - Country:US
Mailing Address - Phone:305-321-3107
Mailing Address - Fax:
Practice Address - Street 1:340 ALHAMBRA CIR
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-5004
Practice Address - Country:US
Practice Address - Phone:305-442-6422
Practice Address - Fax:305-444-8122
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00124261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice