Provider Demographics
NPI:1821405218
Name:VELK FAMILY DENTISTRY
Entity Type:Organization
Organization Name:VELK FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:DUANE
Authorized Official - Last Name:VELK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-609-0445
Mailing Address - Street 1:32475 CLINTON KEITH RD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:WILDOMAR
Mailing Address - State:CA
Mailing Address - Zip Code:92595
Mailing Address - Country:US
Mailing Address - Phone:951-609-0445
Mailing Address - Fax:951-609-1338
Practice Address - Street 1:32475 CLINTON KEITH RD
Practice Address - Street 2:SUITE 115
Practice Address - City:WILDOMAR
Practice Address - State:CA
Practice Address - Zip Code:92595
Practice Address - Country:US
Practice Address - Phone:951-609-0445
Practice Address - Fax:951-609-1338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-17
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44375122300000X
CA44376122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty