Provider Demographics
NPI:1811986557
Name:VAZQUEZ, IVAN A (DDS)
Entity type:Individual
Prefix:DR
First Name:IVAN
Middle Name:A
Last Name:VAZQUEZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:801 MOTOR PKWY
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-5256
Mailing Address - Country:US
Mailing Address - Phone:631-348-1501
Mailing Address - Fax:631-851-9334
Practice Address - Street 1:801 MOTOR PKWY
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-5256
Practice Address - Country:US
Practice Address - Phone:631-348-1501
Practice Address - Fax:631-851-9334
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY0434871223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry