Healthcare Provider Details

I. General information

NPI: 1508005984
Provider Name (Legal Business Name): DAVID E VAZQUEZ-MORALES DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2009
Last Update Date: 12/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

A1 AVE MUNOZ RIVERA SUITE 302 CIRUGIA AMBULATORIA
CAGUAS PR
00726
US

IV. Provider business mailing address

PO BOX 870
CAGUAS PR
00726-0870
US

V. Phone/Fax

Practice location:
  • Phone: 787-744-3087
  • Fax: 787-704-8165
Mailing address:
  • Phone: 787-744-3087
  • Fax: 787-704-8165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number053129
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number2758
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: