Provider Demographics
NPI:1114006079
Name:VELAZQUEZ RAMON, JORGE ALFREDO (DMD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:ALFREDO
Last Name:VELAZQUEZ RAMON
Suffix:
Gender:M
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:PO BOX 51516
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00950-1516
Mailing Address - Country:US
Mailing Address - Phone:787-798-8888
Mailing Address - Fax:787-779-2707
Practice Address - Street 1:28 CALLE PALMER
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-6334
Practice Address - Country:US
Practice Address - Phone:787-798-8888
Practice Address - Fax:787-779-2707
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR04501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice