Provider Demographics
NPI:1811906746
Name:OTERO VAZQUEZ, NOEMI ESTHER (DMD)
Entity type:Individual
Prefix:
First Name:NOEMI
Middle Name:ESTHER
Last Name:OTERO VAZQUEZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P O BOX 19387
Mailing Address - Street 2:FERNANDEZ JUNCOS STATION
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00910-1387
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:MEDICAL PAVILION #14CALLE SAN RAFAEL SANTURCE
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909
Practice Address - Country:US
Practice Address - Phone:787-722-4660
Practice Address - Fax:787-722-4660
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice