Provider Demographics
NPI:1215080452
Name:GLENN ONG-VELOSO A DENTAL CORPORATION
Entity type:Organization
Organization Name:GLENN ONG-VELOSO A DENTAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:LANZAR
Authorized Official - Last Name:ONG-VELOSO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-373-1950
Mailing Address - Street 1:21007 NEMOPHILIA ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:CALIFORNIA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:93505-1963
Mailing Address - Country:US
Mailing Address - Phone:760-373-1950
Mailing Address - Fax:760-373-0072
Practice Address - Street 1:21007 NEMOPHILIA ST
Practice Address - Street 2:SUITE B
Practice Address - City:CALIFORNIA CITY
Practice Address - State:CA
Practice Address - Zip Code:93505-1963
Practice Address - Country:US
Practice Address - Phone:760-373-1950
Practice Address - Fax:760-373-0072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB44316-1OtherHEALTHY FAMILIES
CAG91712-02OtherDENTI-CAL