Provider Demographics
NPI:1427161116
Name:VELOZ, RICARDO JOSE (DDS)
Entity type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:JOSE
Last Name:VELOZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 KENWOOD PL FL 2
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-1652
Mailing Address - Country:US
Mailing Address - Phone:201-328-2815
Mailing Address - Fax:718-492-0229
Practice Address - Street 1:473-52ND STREET
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220
Practice Address - Country:US
Practice Address - Phone:718-492-7154
Practice Address - Fax:718-492-0229
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052469-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0002699425Medicaid