MEDICARE: MARTIN R VELEZ DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	8000	CO

General Provider Information

NPI Number	:	1154322535
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTIN R VELEZ DDS

Provider Business Mailing Address
First Line	:	14118 SEABISCUIT
Second Line	:
City	:	ALPHARETTA
State	:	GA
Zip	:	30004
Country	:	US
Telephone Number	:	770-837-0885
Fax Number	:

Provider Business Practice Location Address
First Line	:	3400-C OLD MILTON PKWY
Second Line	:	SUITE 5
City	:	ALPHARETTA
State	:	GA
Zip	:	30005
Country	:	US
Telephone Number	:	770-837-0885
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	08/21/2013

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