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General NPI Number Information
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NPI Number | 1598121402
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Entity Type | Individual
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Provider Name | GLORIA C MONDRAGON VELEZ DMD
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Gender | Female
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Dates
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Enumeration Date | 01/07/2016
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Last Update Date | 03/06/2020
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Provider Practice Location Address
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Address Line | 2730 UNIVERSITY BLVD W STE 1010
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City | SILVER SPRING
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State | MD
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Zip | 20902-5902
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Country | US
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Telephone | 240-752-8822
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Fax | 240-752-8821
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Provider Business Mailing Address
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Address Line | 510 NW 84 AVE APT 539
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City | PLANTATION
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State | FL
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Zip | 33324-2120
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Country | US
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Telephone | 786-515-5772
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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 | DN21573
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DN21573
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 17173
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License Number State | MD
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