Individual
DIANE VASQUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
2690 GRAVOIS RD, HIGH RIDGE, MO 63049-2508
(636) 692-5803
Mailing address
1635 CLAYTON SPUR CT, ELLISVILLE, MO 63011-2012
(213) 915-1661
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2018002617
MO
Other
Enumeration date
08/05/2015
Last updated
01/04/2022
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