Healthcare Provider Details

I. General information

NPI: 1396100830
Provider Name (Legal Business Name): AL VILLALOBOS DMD P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2015
Last Update Date: 10/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 N US HIGHWAY 1 SUITE 6
TEQUESTA FL
33469-3228
US

IV. Provider business mailing address

1620 N US HIGHWAY 1 SUITE 6
TEQUESTA FL
33469-3228
US

V. Phone/Fax

Practice location:
  • Phone: 561-744-0677
  • Fax: 561-743-9067
Mailing address:
  • Phone: 561-744-0677
  • Fax: 561-743-9067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: DAWN CONRAD
Title or Position: MANAGER
Credential:
Phone: 561-744-0677