MEDICARE: GRETCHEN VILLAMIL-DIAZ DDS

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	1223G0001X	General Practice Dentistry	DEN.00206318	CO

General Provider Information

NPI Number	:	1730972050
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRETCHEN VILLAMIL-DIAZ DDS

Provider Business Mailing Address
First Line	:	6253 W JEWELL AVE UNIT 151
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80232-7109
Country	:	US
Telephone Number	:	305-494-1030
Fax Number	:

Provider Business Practice Location Address
First Line	:	275 S SHERIDAN BLVD STE 114
Second Line	:
City	:	LAKEWOOD
State	:	CO
Zip	:	80226-2401
Country	:	US
Telephone Number	:	720-638-9797
Fax Number	:

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

Provider Enumeration Date	:	05/28/2025
Last Update Date	:	05/28/2025

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