Healthcare Provider Details

I. General information

NPI: 1366417859
Provider Name (Legal Business Name): VILLAMOR R. USITA D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11010 FOOTHILL BLVD STE. 120
RANCHO CUCAMONGA CA
91730-7616
US

IV. Provider business mailing address

11010 FOOTHILL BLVD STE. 120
RANCHO CUCAMONGA CA
91730-7616
US

V. Phone/Fax

Practice location:
  • Phone: 909-481-8881
  • Fax: 909-481-7722
Mailing address:
  • Phone: 909-481-8881
  • Fax: 909-481-7722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number43504
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: