Diane Vasquez, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2018002617 Issued in MO

Practice address

2690 Gravois Rd
High Ridge, MO 63049-2508

Phone

(636) 692-5803

NPI assigned

Aug 5, 2015

Last updated

Jan 4, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Diane E Vasquez DDS LLC

  dba Olive Family Dental

  • General Practice Dentistry
  • High Ridge, MO
  • NPI 1801390406
  NPD Authorized official
• Hudec Dental Center of Mentor, Inc.

  dba Hudec Dental

  • General Practice Dentistry
  • Mentor, OH
  • NPI 1477851251
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1438732800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641254400000",
    "number": "1427434190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1635 CLAYTON SPUR CT",
            "city": "ELLISVILLE",
            "state": "MO",
            "postal_code": "630112012",
            "telephone_number": "213-915-1661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2690 GRAVOIS RD",
            "city": "HIGH RIDGE",
            "state": "MO",
            "postal_code": "630492508",
            "telephone_number": "636-692-5803"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VASQUEZ",
        "first_name": "DIANE",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-08-05",
        "last_updated": "2022-01-04",
        "certification_date": "2022-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "2018002617",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karen Suzanne Tharp, RN BC FNP
• Lisa Thatch, O.D.
• Amy Thomas
• Steffanie Thomas, CD
• Mary Margaret Van de Riet, MA CCC SLP
• Kimberly Vinyard, MA
• Wal-Mart Stores East LP (Walmart Pharmacy 10-0313)
• Wal-Mart Stores East, LP (Walmart Vision Center 30-0313)
• Walgreen Co (Walgreens #04702)
• Warrior Service Company LLC

• General Practice Dentistry in High Ridge, MO
• Providers in High Ridge, MO by specialty
• General Practice Dentistry in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.