Provider Demographics
NPI:1326399528
Name:VELOZ DENTAL PA
Entity Type:Organization
Organization Name:VELOZ DENTAL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:YIRENIA
Authorized Official - Last Name:VELOZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:954-472-6555
Mailing Address - Street 1:9633 W BROWARD BLVD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-2332
Mailing Address - Country:US
Mailing Address - Phone:954-472-6555
Mailing Address - Fax:
Practice Address - Street 1:9633 W BROWARD BLVD
Practice Address - Street 2:SUITE 10
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-2332
Practice Address - Country:US
Practice Address - Phone:954-472-6555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-27
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN187481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty