Provider Demographics
NPI:1659831279
Name:GARCIA VELASCO, WILLIAM JAVIER (GENERAL DENTIST)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JAVIER
Last Name:GARCIA VELASCO
Suffix:
Gender:M
Credentials:GENERAL DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7789 BRISTOL CIR
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34120-0702
Mailing Address - Country:US
Mailing Address - Phone:239-302-0404
Mailing Address - Fax:
Practice Address - Street 1:10061 UNIVERSITY PLAZA DR UNIT 2
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33913-6015
Practice Address - Country:US
Practice Address - Phone:239-310-0303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-20
Last Update Date:2024-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN262221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice