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General NPI Number Information
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NPI Number | 1366584146
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Entity Type | Individual
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Provider Name | EDUARDO VASQUEZ D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 06/01/2021
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Provider Practice Location Address
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Address Line | 501 S IDAHO ST SUITE 120
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City | LA HABRA
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State | CA
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Zip | 90631-6047
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Country | US
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Telephone | 562-690-0400
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Fax |
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Provider Business Mailing Address
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Address Line | 12859 PALM ST
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City | GARDEN GROVE
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State | CA
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Zip | 92840-6401
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Country | US
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Telephone | 714-534-1237
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number | 49825
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 49825
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 49825
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License Number State | CA
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