MEDICARE: ANGEL R VASQUEZ DMD

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	122300000X	Dentist	DN20899	FL
2	1223G0001X	General Practice Dentistry	DN20899	FL

General Provider Information

NPI Number	:	1841690997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGEL R VASQUEZ DMD

Provider Business Mailing Address
First Line	:	1241 AIRPORT RD STE D
Second Line	:
City	:	DESTIN
State	:	FL
Zip	:	32541-2954
Country	:	US
Telephone Number	:	850-428-9244
Fax Number	:

Provider Business Practice Location Address
First Line	:	1241 AIRPORT RD STE D
Second Line	:
City	:	DESTIN
State	:	FL
Zip	:	32541-2954
Country	:	US
Telephone Number	:	850-428-9244
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2014
Last Update Date	:	08/26/2025

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Directions to “ ANGEL R VASQUEZ DMD” Practice Location

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