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General NPI Number Information
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NPI Number | 1750453304
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Entity Type | Individual
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Provider Name | VANESSA QUREISHI VELILLA D.D.S., M.S.
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Gender | Female
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 195 S MAPLE AVE PEDIATRIC DENTAL ASSOCIATES
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City | RIDGEWOOD
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State | NJ
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Zip | 07450-5142
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Country | US
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Telephone | 201-652-7020
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Fax | 201-652-1550
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Provider Business Mailing Address
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Address Line | 121 W 92ND ST APT. GF
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City | NEW YORK
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State | NY
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Zip | 10025-7576
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Country | US
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Telephone | 212-666-1296
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 22DI02206500
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License Number State | NJ
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