MEDICARE: DR. PATRICIA VILLALTA DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	DN 18711	FL
2	1223P0221X	Pediatric Dentistry	29480	TX
3	1223P0221X	Pediatric Dentistry	10522	CO

General Provider Information

NPI Number	:	1013216605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICIA VILLALTA DMD

Provider Business Mailing Address
First Line	:	9131 DOLLANGER CT
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32819-4064
Country	:	US
Telephone Number	:	954-661-8608
Fax Number	:

Provider Business Practice Location Address
First Line	:	1645 E HWY 50
Second Line	:
City	:	CLERMONT
State	:	FL
Zip	:	34711-5199
Country	:	US
Telephone Number	:	954-661-8608
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2011
Last Update Date	:	05/04/2015

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