Provider Demographics
NPI:1013066828
Name:VASPER DENTAL MANAGEMENT SERVICES, LLC
Entity Type:Organization
Organization Name:VASPER DENTAL MANAGEMENT SERVICES, LLC
Other - Org Name:CONTINENTAL DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:
Authorized Official - Last Name:VASQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-248-9614
Mailing Address - Street 1:3614 N 15TH AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-5576
Mailing Address - Country:US
Mailing Address - Phone:602-248-9614
Mailing Address - Fax:602-274-2890
Practice Address - Street 1:3614 N 15TH AVE
Practice Address - Street 2:SUITE B
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-5576
Practice Address - Country:US
Practice Address - Phone:602-248-9614
Practice Address - Fax:602-274-2890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty