Provider Demographics
NPI:1972820579
Name:VELENCHIK, XANDRA H (DMD)
Entity Type:Individual
Prefix:DR
First Name:XANDRA
Middle Name:H
Last Name:VELENCHIK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5053 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER CENTER
Mailing Address - State:VT
Mailing Address - Zip Code:05255
Mailing Address - Country:US
Mailing Address - Phone:802-768-8595
Mailing Address - Fax:802-768-8595
Practice Address - Street 1:5053 MAIN STREET
Practice Address - Street 2:
Practice Address - City:MANCHESTER CENTER
Practice Address - State:VT
Practice Address - Zip Code:05255
Practice Address - Country:US
Practice Address - Phone:802-768-8595
Practice Address - Fax:802-768-8595
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-23
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0092601223G0001X
VT999491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice