Provider Demographics
NPI:1578750378
Name:VACA, ROBERT (DDS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:VACA
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 1:44100 JEFFERSON ST # D
Mailing Address - Street 2:SUITE 404
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-2712
Mailing Address - Country:US
Mailing Address - Phone:760-772-0214
Mailing Address - Fax:760-772-0583
Practice Address - Street 1:44100 JEFFERSON ST # D
Practice Address - Street 2:SUITE 404
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-2712
Practice Address - Country:US
Practice Address - Phone:760-772-0214
Practice Address - Fax:760-772-0583
Is Sole Proprietor?:No
Enumeration Date:2007-09-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA546841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice