Provider Demographics
NPI:1205045432
Name:DR JOHN ASHTON VELLEQUETTE, DDS, PC
Entity Type:Organization
Organization Name:DR JOHN ASHTON VELLEQUETTE, DDS, PC
Other - Org Name:DR. JOHN VELLEQUETTE & ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ASHTON
Authorized Official - Last Name:VELLEQUETTE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PC
Authorized Official - Phone:408-245-7500
Mailing Address - Street 1:877 W FREMONT AVE
Mailing Address - Street 2:SUITE L 3
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-2315
Mailing Address - Country:US
Mailing Address - Phone:408-245-7500
Mailing Address - Fax:408-245-7537
Practice Address - Street 1:877 W FREMONT AVE
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-2315
Practice Address - Country:US
Practice Address - Phone:408-245-7500
Practice Address - Fax:408-245-7537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29513261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental