Provider Demographics
NPI:1093803645
Name:VELASQUEZ, JESUS MARIO (DDS)
Entity Type:Individual
Prefix:DR
First Name:JESUS
Middle Name:MARIO
Last Name:VELASQUEZ
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 1:9388 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063-3947
Mailing Address - Country:US
Mailing Address - Phone:713-785-3355
Mailing Address - Fax:713-785-7007
Practice Address - Street 1:9388 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-3947
Practice Address - Country:US
Practice Address - Phone:713-785-3355
Practice Address - Fax:713-785-7007
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX180001223G0001X, 1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223G0001XDental ProvidersDentistGeneral Practice
Not Answered1223P0300XDental ProvidersDentistPeriodontics