Provider Demographics
NPI:1114620176
Name:VEGA, RENE ALEJANDRO (DDS)
Entity type:Individual
Prefix:DR
First Name:RENE
Middle Name:ALEJANDRO
Last Name:VEGA
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 1:12841 SW 147TH TERRACE RD
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-6328
Mailing Address - Country:US
Mailing Address - Phone:786-585-0271
Mailing Address - Fax:
Practice Address - Street 1:12841 SW 147TH TERRACE RD
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-6328
Practice Address - Country:US
Practice Address - Phone:786-585-0271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-27
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN29041122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist