Healthcare Provider Details

I. General information

NPI: 1366536823
Provider Name (Legal Business Name): MICHELLE T VILLANUEVA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21321 E OCOTILLO RD STE 112
QUEEN CREEK AZ
85142-5993
US

IV. Provider business mailing address

21321 E OCOTILLO RD
QUEEN CREEK AZ
85142-5996
US

V. Phone/Fax

Practice location:
  • Phone: 480-882-9710
  • Fax: 480-882-9706
Mailing address:
  • Phone: 480-882-9710
  • Fax: 480-882-9710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD6398
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: