Provider Demographics
NPI:1407967607
Name:VELAZQUEZ, NORBERTO (DMD)
Entity Type:Individual
Prefix:DR
First Name:NORBERTO
Middle Name:
Last Name:VELAZQUEZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 OAKMONT DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-5936
Mailing Address - Country:US
Mailing Address - Phone:252-756-7789
Mailing Address - Fax:252-756-1466
Practice Address - Street 1:120 OAKMONT DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5936
Practice Address - Country:US
Practice Address - Phone:252-756-7789
Practice Address - Fax:252-756-1466
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7815122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89902WAMedicaid