Healthcare Provider Details

I. General information

NPI: 1508696907
Provider Name (Legal Business Name): BEATRIZ FONSECA VAZQUEZ DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2024
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10843 NW 12TH CT
PLANTATION FL
33322-6929
US

IV. Provider business mailing address

10843 NW 12TH CT
PLANTATION FL
33322-6929
US

V. Phone/Fax

Practice location:
  • Phone: 561-843-5778
  • Fax:
Mailing address:
  • Phone: 561-843-5778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number32310
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: