Provider Demographics
NPI:1649352378
Name:VASQUEZ, DANIELLA A (DENTIST-DDS)
Entity type:Individual
Prefix:DR
First Name:DANIELLA
Middle Name:A
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:DENTIST-DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5533 E BELL RD STE 115
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-1256
Mailing Address - Country:US
Mailing Address - Phone:602-296-3235
Mailing Address - Fax:602-296-3239
Practice Address - Street 1:5533 E BELL RD
Practice Address - Street 2:SUITE 115
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-1228
Practice Address - Country:US
Practice Address - Phone:602-296-3235
Practice Address - Fax:602-296-3239
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD58641223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ797425Medicaid