Provider Demographics
NPI:1174358451
Name:VELAZQUEZ CAMPOS, IVETTE M (DMD)
Entity type:Individual
Prefix:DR
First Name:IVETTE
Middle Name:M
Last Name:VELAZQUEZ CAMPOS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 E 9TH ST APT 13
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-4235
Mailing Address - Country:US
Mailing Address - Phone:786-663-4807
Mailing Address - Fax:
Practice Address - Street 1:5810 S UNIVERSITY DR STE 128
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-6109
Practice Address - Country:US
Practice Address - Phone:954-905-6633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN29348122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist