Provider Demographics
NPI:1811564123
Name:DESANTIAGO-VAZQUEZ, GABRIELA (DDS)
Entity Type:Individual
Prefix:DR
First Name:GABRIELA
Middle Name:
Last Name:DESANTIAGO-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 1:947 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:CA
Mailing Address - Zip Code:95648-2036
Mailing Address - Country:US
Mailing Address - Phone:916-622-8675
Mailing Address - Fax:
Practice Address - Street 1:14001 E ILIFF AVE STE 104
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-1424
Practice Address - Country:US
Practice Address - Phone:303-337-0047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-06
Last Update Date:2023-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.00205740122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist