Provider Demographics
NPI:1336127786
Name:VELASQUEZ-PLATA, DIEGO (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:DIEGO
Middle Name:
Last Name:VELASQUEZ-PLATA
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 TORREY RD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-3327
Mailing Address - Country:US
Mailing Address - Phone:810-750-3400
Mailing Address - Fax:
Practice Address - Street 1:1100 TORREY RD
Practice Address - Street 2:SUITE 500
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-3327
Practice Address - Country:US
Practice Address - Phone:810-750-3400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI182701223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics