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General NPI Number Information
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NPI Number | 1225404023
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Entity Type | Organization
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Legal Business Name | G VILLEGAS DDS DENTAL INC
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Dates
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Enumeration Date | 08/15/2015
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Last Update Date | 07/30/2020
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Provider Practice Location Address
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Address Line | 1126 N FLOWER ST SUITE #A
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City | SANTA ANA
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State | CA
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Zip | 92703-2385
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Country | US
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Telephone | 657-247-0570
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Fax | 657-247-0569
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Provider Business Mailing Address
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Address Line | 1126 N FLOWER ST SUITE #A
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City | SANTA ANA
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State | CA
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Zip | 92703-2385
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Country | US
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Telephone | 657-247-0570
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Fax | 657-247-0569
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | GLORIA ESTELLA VILLEGAS
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Credential |
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Telephone | 949-648-4769
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 58271
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License Number State | CA
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