MEDICARE: DR. THERESA EUSEBIO VILLANO D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	43740	CA

General Provider Information

NPI Number	:	1053518472
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THERESA EUSEBIO VILLANO D.D.S.

Provider Business Mailing Address
First Line	:	2161 YGNACIO VALLEY RD
Second Line	:	#110
City	:	WALNUT CREEK
State	:	CA
Zip	:	94598-3396
Country	:	US
Telephone Number	:	925-937-2273
Fax Number	:

Provider Business Practice Location Address
First Line	:	2161 YGNACIO VALLEY RD
Second Line	:
City	:	WALNUT CREEK
State	:	CA
Zip	:	94598-3396
Country	:	US
Telephone Number	:	925-937-2273
Fax Number	:	925-937-9337

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2007
Last Update Date	:	07/08/2007

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