Provider Demographics
NPI:1457714032
Name:BAYRON VAZQUEZ, DHARMA IVONNE
Entity Type:Individual
Prefix:MRS
First Name:DHARMA
Middle Name:IVONNE
Last Name:BAYRON VAZQUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:F15 CALLE CORRIENTE
Mailing Address - Street 2:URB. EL REMANSO
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6108
Mailing Address - Country:US
Mailing Address - Phone:787-552-8787
Mailing Address - Fax:
Practice Address - Street 1:14750 NW 77TH CT STE 301
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-1537
Practice Address - Country:US
Practice Address - Phone:305-823-9463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-01
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLDN249431223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program