Provider Demographics
NPI:1639785223
Name:VAEZ, MERCEDEH NICOLE (DMD)
Entity Type:Individual
Prefix:DR
First Name:MERCEDEH
Middle Name:NICOLE
Last Name:VAEZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 GRANGEMILL CRESCENT
Mailing Address - Street 2:
Mailing Address - City:TORONTO
Mailing Address - State:ON
Mailing Address - Zip Code:M3B2J3
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3435 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-3001
Practice Address - Country:US
Practice Address - Phone:716-829-6637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-18
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0618721223G0001X
CA1055351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice