Provider Demographics
NPI:1457498859
Name:VELAZQUEZ, DAPHNE MARIE (DDS)
Entity Type:Individual
Prefix:
First Name:DAPHNE
Middle Name:MARIE
Last Name:VELAZQUEZ
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 1:18301 N 79TH AVE
Mailing Address - Street 2:SUITE G-186
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-8463
Mailing Address - Country:US
Mailing Address - Phone:623-776-2494
Mailing Address - Fax:
Practice Address - Street 1:18301 N 79TH AVE
Practice Address - Street 2:SUITE G-186
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8463
Practice Address - Country:US
Practice Address - Phone:623-776-2494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD57021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1922067404OtherNPI ORGANIZATIONAL NUMBER