Provider Demographics
NPI:1932549094
Name:VELASQUEZ, KENDRA (DDS)
Entity type:Individual
Prefix:DR
First Name:KENDRA
Middle Name:
Last Name:VELASQUEZ
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 1:8423 FRONT ROYAL CT NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-3860
Mailing Address - Country:US
Mailing Address - Phone:505-620-2647
Mailing Address - Fax:
Practice Address - Street 1:1904 WELLSPRING AVE SE STE 101
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-4888
Practice Address - Country:US
Practice Address - Phone:505-896-6654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-02
Last Update Date:2024-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD39081223G0001X
CODEN00203020122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice