Provider Demographics
NPI:1417744350
Name:JAN VASQUEZ DENTAL CORPORATION
Entity type:Organization
Organization Name:JAN VASQUEZ DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYANN
Authorized Official - Middle Name:
Authorized Official - Last Name:VASQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:909-967-8811
Mailing Address - Street 1:176 AUBURN CT STE 3
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362-3679
Mailing Address - Country:US
Mailing Address - Phone:909-967-8811
Mailing Address - Fax:
Practice Address - Street 1:1116 N EUCLID ST
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-1955
Practice Address - Country:US
Practice Address - Phone:909-967-8811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-23
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty