Provider Demographics
NPI:1417337569
Name:VELEZ DENTAL GROUP, LLC
Entity Type:Organization
Organization Name:VELEZ DENTAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:ESTEBAN
Authorized Official - Last Name:VELEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-745-6355
Mailing Address - Street 1:5055 E US HIGHWAY 36 STE 101
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-6533
Mailing Address - Country:US
Mailing Address - Phone:317-745-6355
Mailing Address - Fax:317-745-7929
Practice Address - Street 1:5055 E US HIGHWAY 36 STE 101
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-6533
Practice Address - Country:US
Practice Address - Phone:317-745-6355
Practice Address - Fax:317-745-7929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-04
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012316A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty