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General NPI Number Information
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NPI Number | 1568558807
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Entity Type | Individual
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Provider Name | LYDIA LINDA GONZALEZ-VILLARREAL DDS
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Gender | Female
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 06/13/2024
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Provider Practice Location Address
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Address Line | 5250 BLANCO RD
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City | SAN ANTONIO
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State | TX
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Zip | 78216-7017
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Country | US
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Telephone | 210-621-8821
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Fax |
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Provider Business Mailing Address
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Address Line | 17603 KRUGERRAND DR
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City | SAN ANTONIO
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State | TX
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Zip | 78232
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Country | US
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Telephone | 210-525-1600
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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 | 14709
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License Number State | TX
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