Provider Demographics
NPI:1750590741
Name:VELEZ, MARTHA IMELDA (DDS)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:IMELDA
Last Name:VELEZ
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 1:469 N FRESNO ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93701-2311
Mailing Address - Country:US
Mailing Address - Phone:559-443-7494
Mailing Address - Fax:559-443-7409
Practice Address - Street 1:469 N FRESNO ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93701-2311
Practice Address - Country:US
Practice Address - Phone:559-443-7494
Practice Address - Fax:559-443-7409
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA470051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice