Provider Demographics
NPI:1821329285
Name:VELORIA, TOM SERAFICA (DMD)
Entity Type:Individual
Prefix:DR
First Name:TOM
Middle Name:SERAFICA
Last Name:VELORIA
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 1:415 CHALAN SAN ANTONIO
Mailing Address - Street 2:SUITE 303
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96913-3620
Mailing Address - Country:US
Mailing Address - Phone:671-646-5146
Mailing Address - Fax:671-646-8690
Practice Address - Street 1:415 CHALAN SAN ANTONIO
Practice Address - Street 2:SUITE 303
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913-3620
Practice Address - Country:US
Practice Address - Phone:671-646-5146
Practice Address - Fax:671-646-8690
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-26
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUD001401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice