Provider Demographics
NPI:1124227947
Name:ALFREDO VELAZQUEZ DDS, INC
Entity Type:Organization
Organization Name:ALFREDO VELAZQUEZ DDS, INC
Other - Org Name:CENTRAL CITY DENTAL OFFICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ALFREDO
Authorized Official - Middle Name:
Authorized Official - Last Name:VELAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-383-8328
Mailing Address - Street 1:189 N E ST
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92401-1901
Mailing Address - Country:US
Mailing Address - Phone:909-383-8328
Mailing Address - Fax:909-383-8332
Practice Address - Street 1:189 N E ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92401-1901
Practice Address - Country:US
Practice Address - Phone:909-383-8328
Practice Address - Fax:909-383-8332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty