Provider Demographics
NPI:1578742847
Name:VASKO, DEREK A (DDS)
Entity Type:Individual
Prefix:MR
First Name:DEREK
Middle Name:A
Last Name:VASKO
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 1:3150 DUSTIN RD
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:OH
Mailing Address - Zip Code:43616
Mailing Address - Country:US
Mailing Address - Phone:419-693-0781
Mailing Address - Fax:419-693-2405
Practice Address - Street 1:3150 DUSTIN RD
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616
Practice Address - Country:US
Practice Address - Phone:419-693-0781
Practice Address - Fax:419-693-2405
Is Sole Proprietor?:No
Enumeration Date:2007-11-02
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH21086122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist