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General NPI Number Information
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NPI Number | 1528794815
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Entity Type | Organization
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Legal Business Name | RUBEN JESUS VILLA DDS,INC
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Dates
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Enumeration Date | 07/28/2022
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Last Update Date | 07/28/2022
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Provider Practice Location Address
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Address Line | 95 W 11TH ST STE 202
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City | TRACY
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State | CA
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Zip | 95376-3961
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Country | US
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Telephone | 209-229-8108
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Fax |
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Provider Business Mailing Address
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Address Line | 695 LARKSPUR DR
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City | TRACY
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State | CA
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Zip | 95376-9782
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Country | US
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Telephone | 209-207-1353
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. RUBEN VILLA
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Credential | DDS
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Telephone | 209-207-1353
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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 |
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License Number State |
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