Organization
GREENWAY 40 LLC
Active
Other names
Age Defying Dentistry, Phoenix
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID J VELASCO JR. DDS (CO-OWNER)
(602) 595-1115
Entity
Organization
Contact information
Practice address
4022 E GREENWAY RD, STE 13, PHOENIX, AZ 85032-4797
(602) 595-1115
Mailing address
4022 E GREENWAY RD, STE 13, PHOENIX, AZ 85032-4799
(602) 595-1115
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
AZ3740
AZ
122300000X
Dentist
AZ4044
AZ
Other
Enumeration date
07/01/2011
Last updated
08/02/2012
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