Provider Demographics
NPI:1376702233
Name:J MARIO VELASQUEZ DDS
Entity Type:Organization
Organization Name:J MARIO VELASQUEZ DDS
Other - Org Name:DENTAL INNOVATIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ DR.
Authorized Official - Prefix:DR
Authorized Official - First Name:JESUS
Authorized Official - Middle Name:MARIO
Authorized Official - Last Name:VELASQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-928-3311
Mailing Address - Street 1:900 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77012-2127
Mailing Address - Country:US
Mailing Address - Phone:713-928-3311
Mailing Address - Fax:
Practice Address - Street 1:900 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77012-2127
Practice Address - Country:US
Practice Address - Phone:713-928-3311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-05
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty