Healthcare Provider Details

I. General information

NPI: 1154322535
Provider Name (Legal Business Name): MARTIN R VELEZ DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 08/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400-C OLD MILTON PKWY SUITE 5
ALPHARETTA GA
30005
US

IV. Provider business mailing address

14118 SEABISCUIT
ALPHARETTA GA
30004
US

V. Phone/Fax

Practice location:
  • Phone: 770-837-0885
  • Fax:
Mailing address:
  • Phone: 770-837-0885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number8000
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: