Provider Demographics
NPI:1932443017
Name:VAZQUEZ COLON, HUMBERTO OMAR (DMD, BS)
Entity Type:Individual
Prefix:
First Name:HUMBERTO
Middle Name:OMAR
Last Name:VAZQUEZ COLON
Suffix:
Gender:M
Credentials:DMD, BS
Other - Prefix:DR
Other - First Name:HUMBERTO
Other - Middle Name:
Other - Last Name:VAZQUEZ COLON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD, BS
Mailing Address - Street 1:7010 PASEO LA FORTUNA
Mailing Address - Street 2:
Mailing Address - City:COTO LAUREL
Mailing Address - State:PR
Mailing Address - Zip Code:00780-2306
Mailing Address - Country:US
Mailing Address - Phone:787-612-7597
Mailing Address - Fax:
Practice Address - Street 1:7010 PASEO LA FORTUNA
Practice Address - Street 2:
Practice Address - City:COTO LAUREL
Practice Address - State:PR
Practice Address - Zip Code:00780-2306
Practice Address - Country:US
Practice Address - Phone:787-612-7597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR29121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice