Provider Demographics
NPI:1114970662
Name:VEAZEY, WILLIAM S (DMD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:S
Last Name:VEAZEY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3246 CENTENNIAL BLVD # 184
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-4077
Mailing Address - Country:US
Mailing Address - Phone:719-314-9391
Mailing Address - Fax:
Practice Address - Street 1:729 W US HIGHWAY 50
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-1603
Practice Address - Country:US
Practice Address - Phone:719-542-4000
Practice Address - Fax:719-542-4001
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2024-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00203963122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0Medicaid
NY0Medicaid