Healthcare Provider Details

I. General information

NPI: 1275146755
Provider Name (Legal Business Name): ALAN VAZQUEZ DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2020
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4076 NEELY ROAD
FORT WAINWRIGHT AK
99703
US

IV. Provider business mailing address

4076 NEELY ROAD ATTN: ORAL SURGERY
FORT WAINWRIGHT AK
99703
US

V. Phone/Fax

Practice location:
  • Phone: 907-361-5172
  • Fax:
Mailing address:
  • Phone: 907-361-5172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number11831277-9921
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number242746
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: