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General NPI Number Information
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NPI Number | 1750747234
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Entity Type | Organization
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Legal Business Name | VILLACIS DENTAL CORPORATION
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Dates
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Enumeration Date | 01/13/2016
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Last Update Date | 05/11/2017
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Provider Practice Location Address
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Address Line | 520 E CARSON PLAZA CT STE 101
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City | CARSON
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State | CA
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Zip | 90746-3289
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Country | US
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Telephone | 310-313-5150
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Fax | 310-313-5154
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Provider Business Mailing Address
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Address Line | 520 E. CARSON PLAZA CURT STE 101
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City | CARSON
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State | CA
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Zip | 90746-3844
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Country | US
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Telephone | 310-313-5150
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Fax | 310-313-5154
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Authorized Official
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Title or Position | DDS
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Name | DR. SASKIA M VILLACIS
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Credential |
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Telephone | 310-313-5150
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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 | 41690
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License Number State | CA
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