Provider Demographics
NPI:1750602637
Name:VASQUEZ, DAVID RAUL (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:RAUL
Last Name:VASQUEZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10408 S RIDGEVIEW RD
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-6438
Mailing Address - Country:US
Mailing Address - Phone:913-390-3555
Mailing Address - Fax:913-839-0078
Practice Address - Street 1:10408 S RIDGEVIEW RD
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-6438
Practice Address - Country:US
Practice Address - Phone:913-390-3555
Practice Address - Fax:913-839-0078
Is Sole Proprietor?:No
Enumeration Date:2010-06-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS606691223G0001X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice