Provider Demographics
NPI:1336306505
Name:VELEZ, FERNANDO (DMD)
Entity Type:Individual
Prefix:DR
First Name:FERNANDO
Middle Name:
Last Name:VELEZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1218 SW MILITARY DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78221-1535
Mailing Address - Country:US
Mailing Address - Phone:210-928-2814
Mailing Address - Fax:210-928-2364
Practice Address - Street 1:9533 SOUTHWEST FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-1409
Practice Address - Country:US
Practice Address - Phone:713-774-7774
Practice Address - Fax:713-774-7775
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-16
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX242961223G0001X
CA508401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice