Healthcare Provider Details

I. General information

NPI: 1861725061
Provider Name (Legal Business Name): EUNICE NIEVES VACHET DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2009
Last Update Date: 01/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5337 W GRANDE MARKET DR
APPLETON WI
54913-8442
US

IV. Provider business mailing address

5337 W GRANDE MARKET DR
APPLETON WI
54913-8442
US

V. Phone/Fax

Practice location:
  • Phone: 813-909-3413
  • Fax:
Mailing address:
  • Phone: 920-750-6662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN20408
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: