Provider Demographics
NPI:1194399691
Name:VELOSA J.C DENTAL PRACTICE CORP
Entity Type:Organization
Organization Name:VELOSA J.C DENTAL PRACTICE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:CARLOS
Authorized Official - Last Name:VELOSA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-840-6862
Mailing Address - Street 1:1125 E 17TH ST STE E227
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-2218
Mailing Address - Country:US
Mailing Address - Phone:714-550-0503
Mailing Address - Fax:714-550-4112
Practice Address - Street 1:1125 E 17TH ST STE E227
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-2218
Practice Address - Country:US
Practice Address - Phone:714-550-0503
Practice Address - Fax:714-550-4112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-18
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty