Provider Demographics
NPI:1326797721
Name:VELASTEGUI, ANA MARIA (DDS)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:MARIA
Last Name:VELASTEGUI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 W MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-4510
Mailing Address - Country:US
Mailing Address - Phone:347-256-6033
Mailing Address - Fax:
Practice Address - Street 1:11020 73RD RD STE 1L
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-6351
Practice Address - Country:US
Practice Address - Phone:718-793-0800
Practice Address - Fax:718-793-0841
Is Sole Proprietor?:No
Enumeration Date:2022-03-22
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY063242011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program