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General NPI Number Information
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NPI Number | 1659588820
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Entity Type | Organization
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Legal Business Name | DENTAL INNOVATIONS
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 900 BROADWAY ST
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City | HOUSTON
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State | TX
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Zip | 77012-2127
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Country | US
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Telephone | 713-928-3311
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Fax | 713-928-9253
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Provider Business Mailing Address
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Address Line | 900 BROADWAY ST
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City | HOUSTON
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State | TX
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Zip | 77012-2127
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Country | US
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Telephone | 713-928-3311
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Fax | 713-928-9253
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Authorized Official
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Title or Position | D.D.S.,MS.
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Name | JESUS MARIO VELASQUEZ
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Credential |
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Telephone | 713-785-3355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 18000
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 18000
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 18000
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License Number State | TX
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