Provider Demographics
NPI:1821236118
Name:VAZQUEZ, ENRIQUE (DDS)
Entity Type:Individual
Prefix:
First Name:ENRIQUE
Middle Name:
Last Name:VAZQUEZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4820 EMORY RD.
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79922-1705
Mailing Address - Country:US
Mailing Address - Phone:915-328-2444
Mailing Address - Fax:915-855-2371
Practice Address - Street 1:AVENIDA FRANCISCO VILLA #668
Practice Address - Street 2:
Practice Address - City:CD. JUAREZ
Practice Address - State:CHIHUAHUA
Practice Address - Zip Code:32000
Practice Address - Country:MX
Practice Address - Phone:915-613-4487
Practice Address - Fax:915-855-2371
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-26
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ8073131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice