Provider Demographics
NPI:1598724254
Name:VAZQUEZ, EDGAR F (DMD)
Entity Type:Individual
Prefix:DR
First Name:EDGAR
Middle Name:F
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:PO BOX 1949
Mailing Address - Street 2:
Mailing Address - City:YABUCOA
Mailing Address - State:PR
Mailing Address - Zip Code:00767-1949
Mailing Address - Country:US
Mailing Address - Phone:787-266-0382
Mailing Address - Fax:787-266-0382
Practice Address - Street 1:URB MENDEZ 1 SUITE 6
Practice Address - Street 2:
Practice Address - City:YABUCOA
Practice Address - State:PR
Practice Address - Zip Code:00767
Practice Address - Country:US
Practice Address - Phone:787-893-0160
Practice Address - Fax:787-893-0160
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice