Provider Demographics
NPI:1386258309
Name:VELA-GOMEZ, HOMERO JAVIER (DDS)
Entity type:Individual
Prefix:
First Name:HOMERO
Middle Name:JAVIER
Last Name:VELA-GOMEZ
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 1:8112 STILLMEADOW CT
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-1971
Mailing Address - Country:US
Mailing Address - Phone:956-764-0976
Mailing Address - Fax:
Practice Address - Street 1:5904 WEST DR STE 9
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6029
Practice Address - Country:US
Practice Address - Phone:956-726-9418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-08
Last Update Date:2022-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX366431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice