Provider Demographics
NPI:1376649525
Name:VENEGAS, ENRIQUE DANIEL (DDS)
Entity Type:Individual
Prefix:
First Name:ENRIQUE
Middle Name:DANIEL
Last Name:VENEGAS
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 1:4442 SILVER HOLLOW DRIVE
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78413
Mailing Address - Country:US
Mailing Address - Phone:361-850-9676
Mailing Address - Fax:361-850-9676
Practice Address - Street 1:1315 SANTA FE
Practice Address - Street 2:SUITE 203
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404
Practice Address - Country:US
Practice Address - Phone:361-884-8866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX130451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice