Provider Demographics
NPI:1366690984
Name:BONA, GISELA VELASQUEZ (DDS)
Entity Type:Individual
Prefix:DR
First Name:GISELA
Middle Name:VELASQUEZ
Last Name:BONA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:GISELA
Other - Middle Name:MARIA
Other - Last Name:VELASQUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS, MS
Mailing Address - Street 1:7500 CAMBRIDGE ST STE 3410
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-2032
Mailing Address - Country:US
Mailing Address - Phone:617-319-3105
Mailing Address - Fax:713-500-8210
Practice Address - Street 1:7500 CAMBRIDGE ST
Practice Address - Street 2:SUITE 5403
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2032
Practice Address - Country:US
Practice Address - Phone:713-486-4149
Practice Address - Fax:713-486-4179
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-08
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX242931223P0221X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1366690984Medicaid
TX1964264Medicaid