Healthcare Provider Details

I. General information

NPI: 1003959628
Provider Name (Legal Business Name): MICHAEL VACHER D.D.S., P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 E FLETCHER AVE STE D
TAMPA FL
33612-3429
US

IV. Provider business mailing address

104 E FLETCHER AVE STE D
TAMPA FL
33612-3429
US

V. Phone/Fax

Practice location:
  • Phone: 813-968-4998
  • Fax: 813-968-6611
Mailing address:
  • Phone: 813-968-4998
  • Fax: 813-968-6611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8292
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: