Healthcare Provider Details

I. General information

NPI: 1497894604
Provider Name (Legal Business Name): ZENEIDA G VASQUEZ DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 10/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1224 SW 104TH ST SUITE B
OKLAHOMA CITY OK
73139-3020
US

IV. Provider business mailing address

PO BOX 248874
OKLAHOMA CITY OK
73124-8874
US

V. Phone/Fax

Practice location:
  • Phone: 405-703-1000
  • Fax: 405-703-2277
Mailing address:
  • Phone: 405-848-7974
  • Fax: 405-848-0033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number126
License Number StateOK

VIII. Authorized Official

Name: MRS. ZENEIDA G. VASQUEZ
Title or Position: OWNER
Credential: DDS
Phone: 405-703-1000