=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871576181
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GIL VILLARREAL JR. DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/22/2005
-----------------------------------------------------
Last Update Date | 03/20/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1200 E RIDGE RD SUITE 9
-----------------------------------------------------
City | MCALLEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78503-1527
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-631-7177
-----------------------------------------------------
Fax | 956-631-7168
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1200 E RIDGE RD SUITE 9
-----------------------------------------------------
City | MCALLEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78503-1527
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-631-7177
-----------------------------------------------------
Fax | 956-631-7168
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 15463
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------