Healthcare Provider Details

I. General information

NPI: 1720259096
Provider Name (Legal Business Name): EDUARDO VASQUEZ DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2008
Last Update Date: 03/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12859 PALM ST
GARDEN GROVE CA
92840-6401
US

IV. Provider business mailing address

12859 PALM ST
GARDEN GROVE CA
92840-6401
US

V. Phone/Fax

Practice location:
  • Phone: 714-534-1237
  • Fax: 714-530-1747
Mailing address:
  • Phone: 714-534-1237
  • Fax: 714-530-1747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number49825
License Number StateCA

VIII. Authorized Official

Name: DR. EDUARDO VASQUEZ
Title or Position: DENTIST/OWNER
Credential: DDS
Phone: 714-534-1237