Provider Demographics
NPI:1972649184
Name:VELAZQUEZ, JANNETTE (DMD)
Entity type:Individual
Prefix:DR
First Name:JANNETTE
Middle Name:
Last Name:VELAZQUEZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 AVE SAN MARCOS
Mailing Address - Street 2:EXT. EL COMANDANTE
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00982-3616
Mailing Address - Country:US
Mailing Address - Phone:787-762-6585
Mailing Address - Fax:787-762-6585
Practice Address - Street 1:235 AVE SAN MARCOS
Practice Address - Street 2:EXT. EL COMANDANTE
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00982-3616
Practice Address - Country:US
Practice Address - Phone:787-762-6585
Practice Address - Fax:787-762-6585
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1883122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist