Healthcare Provider Details

I. General information

NPI: 1922708999
Provider Name (Legal Business Name): ANDREA CAMPO-VELEZ DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2023
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 KINGS HWY FL 4
BROOKLYN NY
11223-1349
US

IV. Provider business mailing address

933 HOMESTEAD DR
DESOTO TX
75115-0031
US

V. Phone/Fax

Practice location:
  • Phone: 718-719-1952
  • Fax:
Mailing address:
  • Phone: 972-375-5942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number065413
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: