Provider Demographics
NPI:1790504033
Name:VACCARO, ISABELA (DDS)
Entity type:Individual
Prefix:DR
First Name:ISABELA
Middle Name:
Last Name:VACCARO
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 1:1408 HERMES AVE APT C
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-1677
Mailing Address - Country:US
Mailing Address - Phone:760-557-9105
Mailing Address - Fax:
Practice Address - Street 1:309 S RANCHO SANTA FE RD UNIT G
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-2303
Practice Address - Country:US
Practice Address - Phone:760-744-3333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-04
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS109716122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist