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General NPI Number Information
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NPI Number | 1821405218
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Entity Type | Organization
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Legal Business Name | VELK FAMILY DENTISTRY
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Dates
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Enumeration Date | 07/17/2014
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Last Update Date | 07/17/2014
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Provider Practice Location Address
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Address Line | 32475 CLINTON KEITH RD SUITE 115
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City | WILDOMAR
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State | CA
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Zip | 92595
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Country | US
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Telephone | 951-609-0445
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Fax | 951-609-1338
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Provider Business Mailing Address
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Address Line | 32475 CLINTON KEITH RD SUITE 115
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City | WILDOMAR
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State | CA
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Zip | 92595
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Country | US
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Telephone | 951-609-0445
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Fax | 951-609-1338
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Authorized Official
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Title or Position | OWNER
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Name | ERIC DUANE VELK
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Credential | DDS
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Telephone | 951-609-0445
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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 | 44376
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 44375
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License Number State | CA
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