Provider Demographics
NPI:1538513536
Name:RIVERA VELAZQUEZ, IRELSY ALEXANDRA (DMD, MSD)
Entity Type:Individual
Prefix:DR
First Name:IRELSY
Middle Name:ALEXANDRA
Last Name:RIVERA VELAZQUEZ
Suffix:
Gender:F
Credentials:DMD, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7611 LITTLE RIVER TPKE STE 101E
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-2630
Mailing Address - Country:US
Mailing Address - Phone:703-634-4195
Mailing Address - Fax:
Practice Address - Street 1:7611 LITTLE RIVER TPKE STE 101E
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-2630
Practice Address - Country:US
Practice Address - Phone:787-949-5828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-16
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014178651223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty