Provider Demographics
NPI:1922187046
Name:VAZQUEZ, JOSE A (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:A
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 1:1645 RAND RD
Mailing Address - Street 2:SUITE# 1
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-3551
Mailing Address - Country:US
Mailing Address - Phone:847-813-5217
Mailing Address - Fax:
Practice Address - Street 1:7107 W BELMONT AVE
Practice Address - Street 2:SUITE# 1
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-4688
Practice Address - Country:US
Practice Address - Phone:773-889-6661
Practice Address - Fax:773-889-6663
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190233261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice