Healthcare Provider Details

I. General information

NPI: 1831399302
Provider Name (Legal Business Name): JENNIBETH ROBLES-VELEZ DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2007
Last Update Date: 02/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 TEA OLIVE CT
AIKEN SC
29803-4715
US

IV. Provider business mailing address

20 TEA OLIVE COURT
AIKEN SC
29803
US

V. Phone/Fax

Practice location:
  • Phone: 803-226-9472
  • Fax: 803-648-0057
Mailing address:
  • Phone: 803-226-9472
  • Fax: 803-648-0057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDGD6955
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: