Provider Demographics
NPI:1851918866
Name:LUIS ALFREDO VELAZQUEZ, D.D.S. INC.
Entity Type:Organization
Organization Name:LUIS ALFREDO VELAZQUEZ, D.D.S. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:ALFREDO
Authorized Official - Last Name:VELAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-446-9318
Mailing Address - Street 1:7675 NEWBERRY LN
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-4249
Mailing Address - Country:US
Mailing Address - Phone:951-446-9318
Mailing Address - Fax:
Practice Address - Street 1:8977 FOOTHILL BLVD STE F
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-3498
Practice Address - Country:US
Practice Address - Phone:951-446-9318
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-26
Last Update Date:2020-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty