Healthcare Provider Details

I. General information

NPI: 1720090863
Provider Name (Legal Business Name): JULIA VILLA, D.D.S., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 01/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3431 BROADWAY ST SUITE A-7
AMERICAN CANYON CA
94503-1228
US

IV. Provider business mailing address

3431 BROADWAY ST SUITE A-7
AMERICAN CANYON CA
94503-1228
US

V. Phone/Fax

Practice location:
  • Phone: 707-557-5057
  • Fax: 707-557-4230
Mailing address:
  • Phone: 707-557-5057
  • Fax: 707-557-4230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number38471
License Number StateCA

VIII. Authorized Official

Name: DR. JULIA VILLA
Title or Position: PRESIDENT
Credential: DDS
Phone: 707-557-5057