Provider Demographics
NPI:1851507883
Name:J. MARIO VELASQUEZ D.D.S.
Entity Type:Organization
Organization Name:J. MARIO VELASQUEZ D.D.S.
Other - Org Name:DENTAL INNOVATIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:P
Authorized Official - Last Name:JARAMILLO
Authorized Official - Suffix:
Authorized Official - Credentials:OM
Authorized Official - Phone:713-785-3355
Mailing Address - Street 1:9388 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063-3947
Mailing Address - Country:US
Mailing Address - Phone:713-785-3355
Mailing Address - Fax:713-785-7007
Practice Address - Street 1:9388 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-3947
Practice Address - Country:US
Practice Address - Phone:713-785-3355
Practice Address - Fax:713-785-7007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX009790903Medicaid