Provider Demographics
NPI:1750637492
Name:VASQUEZ-JOHNSON, ZENAIDA (RDH / LPN)
Entity Type:Individual
Prefix:MRS
First Name:ZENAIDA
Middle Name:
Last Name:VASQUEZ-JOHNSON
Suffix:
Gender:F
Credentials:RDH / LPN
Other - Prefix:MS
Other - First Name:ZENAIDA
Other - Middle Name:
Other - Last Name:VASQUEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RDH / LPN
Mailing Address - Street 1:650 HORTON ROAD
Mailing Address - Street 2:
Mailing Address - City:N. MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49445
Mailing Address - Country:US
Mailing Address - Phone:231-744-2387
Mailing Address - Fax:231-744-2387
Practice Address - Street 1:650 HORTON ROAD
Practice Address - Street 2:
Practice Address - City:N. MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49445
Practice Address - Country:US
Practice Address - Phone:231-744-2387
Practice Address - Fax:231-744-2387
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-31
Last Update Date:2014-05-12
Deactivation Date:2012-11-01
Deactivation Code:
Reactivation Date:2014-05-12
Provider Licenses
StateLicense IDTaxonomies
MI2902005276124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist