Provider Demographics
NPI:1457094146
Name:VELAZQUEZ, VICTORIA (DDS)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:VELAZQUEZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 E 210TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-2401
Mailing Address - Country:US
Mailing Address - Phone:718-920-2801
Mailing Address - Fax:
Practice Address - Street 1:2361 BRISTOL RD
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-6000
Practice Address - Country:US
Practice Address - Phone:215-752-4514
Practice Address - Fax:215-525-5551
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-19
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PADS0445551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty