Provider Demographics
NPI:1598831091
Name:VASQUEZ GARCIA, JORGE (DDS)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:
Last Name:VASQUEZ GARCIA
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 1:12 WEST 20 STREET
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340
Mailing Address - Country:US
Mailing Address - Phone:209-388-1000
Mailing Address - Fax:209-388-1403
Practice Address - Street 1:12 WEST 20 STREET
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340
Practice Address - Country:US
Practice Address - Phone:209-388-1000
Practice Address - Fax:209-388-1403
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA532861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice