Provider Demographics
NPI:1639295041
Name:ONTIVEROS, JOE C JR (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:JOE
Middle Name:C
Last Name:ONTIVEROS
Suffix:JR
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6516 MD ANDERSON
Mailing Address - Street 2:RESTORATIVE DEPARTMENT, #493
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-3402
Mailing Address - Country:US
Mailing Address - Phone:713-500-4482
Mailing Address - Fax:
Practice Address - Street 1:6516 MD ANDERSON
Practice Address - Street 2:RESTORATIVE DEPARTMENT, #493
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-3402
Practice Address - Country:US
Practice Address - Phone:713-500-4482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19045122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist