Provider Demographics
NPI:1689056038
Name:GLENN ONG-VELOSO DDS INC
Entity Type:Organization
Organization Name:GLENN ONG-VELOSO DDS INC
Other - Org Name:GLENN DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:
Authorized Official - Last Name:ONG-VELOSO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-242-2620
Mailing Address - Street 1:16098 KAMANA RD
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-1335
Mailing Address - Country:US
Mailing Address - Phone:760-242-2620
Mailing Address - Fax:760-242-4700
Practice Address - Street 1:16098 KAMANA RD
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-1335
Practice Address - Country:US
Practice Address - Phone:760-242-2620
Practice Address - Fax:760-242-4700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-22
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44347122300000X
332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty