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General NPI Number Information
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NPI Number | 1194399691
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Entity Type | Organization
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Legal Business Name | VELOSA J.C DENTAL PRACTICE CORP
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Dates
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Enumeration Date | 05/18/2021
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Last Update Date | 05/19/2021
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Provider Practice Location Address
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Address Line | 1125 E 17TH ST STE E227
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City | SANTA ANA
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State | CA
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Zip | 92701-2218
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Country | US
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Telephone | 714-550-0503
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Fax | 714-550-4112
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Provider Business Mailing Address
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Address Line | 1125 E 17TH ST STE E227
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City | SANTA ANA
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State | CA
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Zip | 92701-2218
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Country | US
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Telephone | 714-550-0503
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Fax | 714-550-4112
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Authorized Official
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Title or Position | DENTIST
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Name | DR. JUAN CARLOS VELOSA
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Credential | DDS
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Telephone | 626-840-6862
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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