Provider Demographics
NPI:1710234844
Name:VAZANA, TODD ADAM (DMD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:ADAM
Last Name:VAZANA
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 1:3221 SW 51ST ST
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-7916
Mailing Address - Country:US
Mailing Address - Phone:352-219-0765
Mailing Address - Fax:
Practice Address - Street 1:7807 SW 6TH CT
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-3203
Practice Address - Country:US
Practice Address - Phone:954-472-8844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-08
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN199301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice