Provider Demographics
NPI:1568553469
Name:VELAZQUEZ, ANGEL L (DMD)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:L
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 1:3735 SW 8TH ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-3161
Mailing Address - Country:US
Mailing Address - Phone:305-442-4566
Mailing Address - Fax:
Practice Address - Street 1:3735 SW 8TH ST
Practice Address - Street 2:SUITE 203
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-3161
Practice Address - Country:US
Practice Address - Phone:305-442-4566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 15335122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist