Provider Demographics
NPI:1053652396
Name:MAGALY M VELASQUEZ DDS PROFESSIONAL DENTAL CORP
Entity Type:Organization
Organization Name:MAGALY M VELASQUEZ DDS PROFESSIONAL DENTAL CORP
Other - Org Name:U - FIRST DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MAGALY
Authorized Official - Middle Name:M
Authorized Official - Last Name:VELASQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-466-4999
Mailing Address - Street 1:9130 FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-3449
Mailing Address - Country:US
Mailing Address - Phone:909-466-4999
Mailing Address - Fax:
Practice Address - Street 1:9130 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-3449
Practice Address - Country:US
Practice Address - Phone:909-466-4999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-12
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60169261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental