Provider Demographics
NPI:1053532960
Name:VELA, BENJAMIN RICHARD (DDS)
Entity type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:RICHARD
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 1:4822 HOLLY RD STE C
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-4775
Mailing Address - Country:US
Mailing Address - Phone:361-994-4900
Mailing Address - Fax:361-994-4989
Practice Address - Street 1:4822 HOLLY RD STE C
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4775
Practice Address - Country:US
Practice Address - Phone:361-994-4900
Practice Address - Fax:361-994-4989
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX227591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX22759OtherSTATE LICENSE