Provider Demographics
NPI:1508415100
Name:VASQUEZ, RACHAEL M (DDS)
Entity Type:Individual
Prefix:DR
First Name:RACHAEL
Middle Name:M
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:RACHAEL
Other - Middle Name:
Other - Last Name:DESLOOVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:449 PROSPECT AVE SE APT 1
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-5349
Mailing Address - Country:US
Mailing Address - Phone:734-635-9737
Mailing Address - Fax:
Practice Address - Street 1:550 CHERRY ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-4748
Practice Address - Country:US
Practice Address - Phone:734-635-9737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-05
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901600342122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist