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General NPI Number Information
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NPI Number | 1528332004
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Entity Type | Organization
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Legal Business Name | ROBERTO L VILLARREALDDS
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Dates
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Enumeration Date | 03/01/2012
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Last Update Date | 03/01/2012
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Provider Practice Location Address
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Address Line | 1302 S GENERAL MCMULLEN DR STE 102
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City | SAN ANTONIO
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State | TX
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Zip | 78237-4200
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Country | US
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Telephone | 210-432-7851
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Fax | 210-432-1157
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Provider Business Mailing Address
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Address Line | 1302 S GENERAL MCMULLEN DR STE 102
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City | SAN ANTONIO
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State | TX
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Zip | 78237-4200
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Country | US
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Telephone | 210-432-7851
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Fax | 210-432-1157
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. ROBERTO LUIS VILLARREAL
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Credential | DDS
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Telephone | 210-432-7851
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 22476
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License Number State | TX
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