Active NPI
Andreina Jose Moreno Velasquez
- Dentist
- Waltham, MA
National Provider Identifier
1629963699
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DL100756
- Practice address
- 21 Prospect Hill Ave Unit 2
Waltham, MA 02451-3637 - Phone
- (857) 250-6824
- NPI assigned
- Jun 10, 2025
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DL100756 | MA | Primary |
Addresses
Primary practice location
21 Prospect Hill Ave Unit 2
Waltham, MA 02451-3637
Mailing address
21 Prospect Hill Ave Unit 2
Waltham, MA 02451-3637
Phone (857) 250-6824
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DL100756 | MA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1749513600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1749513600000",
"number": "1629963699",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "21 PROSPECT HILL AVE UNIT 2",
"city": "WALTHAM",
"state": "MA",
"postal_code": "024513637",
"telephone_number": "857-250-6824"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "21 PROSPECT HILL AVE UNIT 2",
"city": "WALTHAM",
"state": "MA",
"postal_code": "024513637",
"telephone_number": "857-250-6824"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MORENO VELASQUEZ",
"first_name": "ANDREINA JOSE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-06-10",
"last_updated": "2025-06-10",
"certification_date": "2025-06-10",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MA",
"license": "DL100756",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waltham, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.