Healthcare Provider Details

I. General information

NPI: 1457714032
Provider Name (Legal Business Name): DHARMA IVONNE BAYRON VAZQUEZ DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2016
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14750 NW 77TH CT STE 301
MIAMI LAKES FL
33016-1537
US

IV. Provider business mailing address

1010 BRICKELL AVE UNIT 3206
MIAMI FL
33131-3779
US

V. Phone/Fax

Practice location:
  • Phone: 305-823-9463
  • Fax:
Mailing address:
  • Phone: 305-813-1655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN24943
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: