Provider Demographics
NPI:1902934524
Name:VELILLA, MORRIS VINCENT (DDS)
Entity Type:Individual
Prefix:DR
First Name:MORRIS
Middle Name:VINCENT
Last Name:VELILLA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39915 GRAND RIVER AVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-2153
Mailing Address - Country:US
Mailing Address - Phone:248-427-9003
Mailing Address - Fax:248-427-9007
Practice Address - Street 1:39915 GRAND RIVER AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-2153
Practice Address - Country:US
Practice Address - Phone:248-427-9003
Practice Address - Fax:248-427-9007
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI161511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice