Provider Demographics
NPI:1588036578
Name:VELAYO GREEN VALLEY SMILES DENTISTRY, PC
Entity Type:Organization
Organization Name:VELAYO GREEN VALLEY SMILES DENTISTRY, PC
Other - Org Name:GREEN VALLEY SMILES DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BIANCA
Authorized Official - Middle Name:C
Authorized Official - Last Name:VELAYO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:702-757-3399
Mailing Address - Street 1:PO BOX 920050
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75392-0050
Mailing Address - Country:US
Mailing Address - Phone:702-757-3399
Mailing Address - Fax:702-425-9719
Practice Address - Street 1:2570 WIGWAM PKWY STE 110
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-6225
Practice Address - Country:US
Practice Address - Phone:702-757-3399
Practice Address - Fax:702-425-9719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-29
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty