Provider Demographics
NPI:1255990255
Name:VELEZ, JACQUELINE ROSE (DMD)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:ROSE
Last Name:VELEZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:ROSE
Other - Last Name:VERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:30 MIAMI DR
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28785-9423
Mailing Address - Country:US
Mailing Address - Phone:828-452-5807
Mailing Address - Fax:
Practice Address - Street 1:30 MIAMI DR
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28785-9423
Practice Address - Country:US
Practice Address - Phone:828-452-5807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-12
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH044921223G0001X
NC136411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice