Provider Demographics
NPI:1952456162
Name:VASQUEZ, RICARDO A (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:A
Last Name:VASQUEZ
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 1:4853 S JACKSON RD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-9793
Mailing Address - Country:US
Mailing Address - Phone:956-630-4755
Mailing Address - Fax:
Practice Address - Street 1:4853 S JACKSON RD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-9793
Practice Address - Country:US
Practice Address - Phone:956-630-4755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX217861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB21786-01OtherCHIPS PROVIDER NUMBER
TX01637598OtherUNITED CONCORDIA TRICARE
TX1703720-01Medicaid