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General NPI Number Information
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NPI Number | 1174358451
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Entity Type | Individual
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Provider Name | IVETTE M VELAZQUEZ CAMPOS DMD
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Gender | Female
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Dates
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Enumeration Date | 09/05/2024
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Last Update Date | 09/05/2024
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Provider Practice Location Address
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Address Line | 5810 S UNIVERSITY DR STE 128
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City | DAVIE
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State | FL
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Zip | 33328-6109
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Country | US
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Telephone | 954-905-6633
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Fax |
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Provider Business Mailing Address
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Address Line | 165 E 9TH ST APT 13
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City | HIALEAH
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State | FL
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Zip | 33010-4235
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Country | US
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Telephone | 786-663-4807
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN29348
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License Number State | FL
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