Provider Demographics
NPI:1972237386
Name:DE LA BARCA DOMINGUEZ, VANESSA (DDS)
Entity type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:
Last Name:DE LA BARCA DOMINGUEZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6891 SW 51ST ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-5707
Mailing Address - Country:US
Mailing Address - Phone:305-305-5830
Mailing Address - Fax:
Practice Address - Street 1:10114 SW 107TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2760
Practice Address - Country:US
Practice Address - Phone:305-305-5830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-12
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL273201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice