Provider Demographics
NPI:1558503896
Name:VAZQUEZ, HUMBERTO J (DDS)
Entity Type:Individual
Prefix:DR
First Name:HUMBERTO
Middle Name:J
Last Name:VAZQUEZ
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 1:620 NW 33RD AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-4106
Mailing Address - Country:US
Mailing Address - Phone:786-786-2355
Mailing Address - Fax:786-422-9041
Practice Address - Street 1:620 NW 33RD AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-4106
Practice Address - Country:US
Practice Address - Phone:786-786-2355
Practice Address - Fax:786-422-9041
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-01
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN124251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice