Provider Demographics
NPI:1386205136
Name:VELA, JEREMY JASON (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:JASON
Last Name:VELA
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 1:1165 E MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:ALICE
Mailing Address - State:TX
Mailing Address - Zip Code:78332-3846
Mailing Address - Country:US
Mailing Address - Phone:361-664-8352
Mailing Address - Fax:361-664-9305
Practice Address - Street 1:1165 E MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:ALICE
Practice Address - State:TX
Practice Address - Zip Code:78332-3846
Practice Address - Country:US
Practice Address - Phone:361-664-8352
Practice Address - Fax:361-664-9305
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-24
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35209122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist