Healthcare Provider Details

I. General information

NPI: 1023947371
Provider Name (Legal Business Name): JORGE FELIX VELAZQUEZ DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 MIRACLE MILE
CORAL GABLES FL
33134-5404
US

IV. Provider business mailing address

13552 SW 38TH LN
MIAMI FL
33175-3214
US

V. Phone/Fax

Practice location:
  • Phone: 305-448-7778
  • Fax: 305-341-0061
Mailing address:
  • Phone: 305-448-7778
  • Fax: 305-341-0061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number99999PENDING
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: