Provider Demographics
NPI:1679903686
Name:VELEZ, JUAN (DMD)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:
Last Name:VELEZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1448 RALEIGH RD
Mailing Address - Street 2:
Mailing Address - City:MAMARONECK
Mailing Address - State:NY
Mailing Address - Zip Code:10543-1237
Mailing Address - Country:US
Mailing Address - Phone:914-826-0973
Mailing Address - Fax:
Practice Address - Street 1:1448 RALEIGH RD
Practice Address - Street 2:
Practice Address - City:MAMARONECK
Practice Address - State:NY
Practice Address - Zip Code:10543-1237
Practice Address - Country:US
Practice Address - Phone:914-826-0973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-13
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY458954101235Z00000X
NY29141223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No1223D0001XDental ProvidersDentistDental Public Health