Provider Demographics
NPI:1588857544
Name:VELA, ERIC THOMAS (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:THOMAS
Last Name:VELA
Suffix:
Gender:M
Credentials:DDS, MS
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Mailing Address - Street 1:5826 ESPLANADE DR STE 301
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-4173
Mailing Address - Country:US
Mailing Address - Phone:361-980-8400
Mailing Address - Fax:361-985-1480
Practice Address - Street 1:5826 ESPLANADE DR STE 301
Practice Address - Street 2:809 N. FLOURNOY RD., ALICE, TX 78332
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-4173
Practice Address - Country:US
Practice Address - Phone:361-980-8400
Practice Address - Fax:361-985-1480
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-23
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0233021223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2100745Medicaid