Healthcare Provider Details

I. General information

NPI: 1366378382
Provider Name (Legal Business Name): MARIE JACQULIN VASQUEZ DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12093 PAPER BIRCH LN
GAINESVILLE VA
20155-5203
US

IV. Provider business mailing address

12093 PAPER BIRCH LN
GAINESVILLE VA
20155-5203
US

V. Phone/Fax

Practice location:
  • Phone: 703-479-9357
  • Fax:
Mailing address:
  • Phone: 703-479-9357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401420031
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: