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General NPI Number Information
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NPI Number | 1225497407
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Entity Type | Individual
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Provider Name | RAZIEL VELGIS DDS, MSD
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Gender | Male
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Dates
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Enumeration Date | 02/17/2016
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Last Update Date | 09/19/2024
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Provider Practice Location Address
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Address Line | 1361 13TH AVE S STE 220
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City | JACKSONVILLE BEACH
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State | FL
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Zip | 32250-3236
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Country | US
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Telephone | 904-273-4373
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Fax |
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Provider Business Mailing Address
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Address Line | 41 CAYMAN CV
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City | PONTE VEDRA
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State | FL
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Zip | 32081-1513
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Country | US
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Telephone |
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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 | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | DN29144
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License Number State | FL
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