Provider Demographics
NPI:1801356886
Name:GLENN ONG- VELOSO DDS INC
Entity Type:Organization
Organization Name:GLENN ONG- VELOSO DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
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 STE 101
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:
Practice Address - Street 1:16098 KAMANA RD STE 101
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-25
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment