Provider Demographics
NPI:1790777951
Name:VAZQUEZ, VERONIKA VIRGINIA (DDS)
Entity Type:Individual
Prefix:DR
First Name:VERONIKA
Middle Name:VIRGINIA
Last Name:VAZQUEZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4360 SLIDE MOUNTAIN CIR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-9530
Mailing Address - Country:US
Mailing Address - Phone:775-453-0142
Mailing Address - Fax:
Practice Address - Street 1:4360 SLIDE MOUNTAIN CIR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-9530
Practice Address - Country:US
Practice Address - Phone:775-453-0142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53884122300000X
NV74301223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery