Provider Demographics
NPI:1972658524
Name:VELASCO, DAVID JOHN JR (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JOHN
Last Name:VELASCO
Suffix:JR
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 1:652 E WARNER RD
Mailing Address - Street 2:STE 101
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-3054
Mailing Address - Country:US
Mailing Address - Phone:480-545-8400
Mailing Address - Fax:480-345-0422
Practice Address - Street 1:652 E WARNER RD
Practice Address - Street 2:STE 101
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-3071
Practice Address - Country:US
Practice Address - Phone:480-545-8400
Practice Address - Fax:480-345-0422
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ37401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice