Provider Demographics
NPI:1255568648
Name:VAZEMILLER, TATYANA (DDS)
Entity type:Individual
Prefix:DR
First Name:TATYANA
Middle Name:
Last Name:VAZEMILLER
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 1:16535 TOWN LAKE CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77059-5546
Mailing Address - Country:US
Mailing Address - Phone:281-979-7688
Mailing Address - Fax:
Practice Address - Street 1:4429 GRIGGS RD STE A
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77021-2852
Practice Address - Country:US
Practice Address - Phone:281-979-7688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-12
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX283541223P0221X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1255568648Medicaid