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General NPI Number Information
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NPI Number | 1801390406
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Entity Type | Organization
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Legal Business Name | DIANE E VASQUEZ DDS LLC
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Dates
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Enumeration Date | 03/20/2018
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Last Update Date | 01/04/2022
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Provider Practice Location Address
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Address Line | 2690 GRAVOIS RD
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City | HIGH RIDGE
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State | MO
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Zip | 63049-2508
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Country | US
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Telephone | 636-692-5803
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Fax |
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Provider Business Mailing Address
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Address Line | 1635 CLAYTON SPUR CT
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City | ELLISVILLE
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State | MO
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Zip | 63011-2012
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Country | US
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Telephone | 213-915-1661
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Fax |
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Authorized Official
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Title or Position | GENERAL DENTIST
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Name | DR. DIANE ELIZABETH VASQUEZ
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Credential | DDS
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Telephone | 213-915-1661
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 2018002617
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License Number State | MO
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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 |
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License Number State |
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