Healthcare Provider Details

I. General information

NPI: 1437385200
Provider Name (Legal Business Name): WALTER VILLANUEVA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2009
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

913 E WARNER RD
GILBERT AZ
85296-3078
US

IV. Provider business mailing address

24 N BULLMOOSE CIR
CHANDLER AZ
85224-4121
US

V. Phone/Fax

Practice location:
  • Phone: 480-398-1372
  • Fax: 602-956-2209
Mailing address:
  • Phone: 480-398-1372
  • Fax: 480-398-1373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberD07782
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: