Healthcare Provider Details

I. General information

NPI: 1538369509
Provider Name (Legal Business Name): STEPHEN JOSEPH VELEZ DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 08/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

432 S DANCY AVE
HASTINGS FL
32145-5428
US

IV. Provider business mailing address

432 S DANCY AVE
HASTINGS FL
32145-5428
US

V. Phone/Fax

Practice location:
  • Phone: 240-406-6483
  • Fax:
Mailing address:
  • Phone: 240-406-6483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN13324
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number014794
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: