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General NPI Number Information
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NPI Number | 1386440006
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Entity Type | Individual
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Provider Name | NICOLA VILLANUEVA DDS
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Gender | Male
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Dates
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Enumeration Date | 02/22/2025
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Last Update Date | 07/09/2025
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Provider Practice Location Address
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Address Line | 2006 N ROCK RD STE 300
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City | DERBY
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State | KS
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Zip | 67037-3857
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Country | US
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Telephone | 316-416-6057
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Fax |
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Provider Business Mailing Address
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Address Line | 1005 N 20TH ST APT 329
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City | OMAHA
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State | NE
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Zip | 68102-4309
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Country | US
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Telephone | 312-522-3280
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 1223G0001X
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License Number State | KS
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