Healthcare Provider Details

I. General information

NPI: 1215806500
Provider Name (Legal Business Name): INDIRA MERCEDES ALVAREZ VASQUEZ DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2025
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6440 NW 114TH AVE UNIT 406
DORAL FL
33178-4572
US

IV. Provider business mailing address

13970 CORONADO DR
SPRING HILL FL
34609-5335
US

V. Phone/Fax

Practice location:
  • Phone: 813-842-9144
  • Fax:
Mailing address:
  • Phone: 813-842-9144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2997
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: