MEDICARE: ROBERT A VAZQUEZ DDS, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0300X	Periodontics

General Provider Information

NPI Number	:	1790593010
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERT A VAZQUEZ DDS, PC

Provider Business Mailing Address
First Line	:	3914 ROSEMONT DR
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-5626
Country	:	US
Telephone Number	:	706-225-2368
Fax Number	:

Provider Business Practice Location Address
First Line	:	3914 ROSEMONT DR
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-5626
Country	:	US
Telephone Number	:	706-225-2368
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF PAYOR CONTRACTING
Name	:	CASEY CASTLE
Credential	:
Telephone Number	:	912-732-1504

Provider Enumeration Date	:	12/19/2024
Last Update Date	:	12/19/2024

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