Healthcare Provider Details

I. General information

NPI: 1790337533
Provider Name (Legal Business Name): TAYLOR VELASQUEZ DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2019
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8955 WOOD RD BLDG 1
BETHESDA MD
20889-5628
US

IV. Provider business mailing address

8955 WOOD RD BLDG 1
BETHESDA MD
20889-5628
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-1550
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD010426
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: