MEDICARE: DR. DIANA-BEATRIX VELICU DDS, MSC, MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	37742	TX

General Provider Information

NPI Number	:	1578238606
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIANA-BEATRIX VELICU DDS, MSC, MS

Provider Business Mailing Address
First Line	:	8110 PARK LN APT 630
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-6094
Country	:	US
Telephone Number	:	443-815-9866
Fax Number	:

Provider Business Practice Location Address
First Line	:	1110 E PARKER RD STE 110
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75074-5363
Country	:	US
Telephone Number	:	972-265-0111
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2021
Last Update Date	:	08/11/2021

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