Provider Demographics
NPI:1457995961
Name:VELASCO, ARELY (DDS)
Entity Type:Individual
Prefix:MRS
First Name:ARELY
Middle Name:
Last Name:VELASCO
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 1:7206 HUGHSON AVE
Mailing Address - Street 2:
Mailing Address - City:HUGHSON
Mailing Address - State:CA
Mailing Address - Zip Code:95326
Mailing Address - Country:US
Mailing Address - Phone:209-883-4477
Mailing Address - Fax:209-883-4499
Practice Address - Street 1:7206 HUGHSON AVE
Practice Address - Street 2:
Practice Address - City:HUGHSON
Practice Address - State:CA
Practice Address - Zip Code:95326
Practice Address - Country:US
Practice Address - Phone:209-883-4477
Practice Address - Fax:209-883-4499
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-29
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103968122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist