MEDICARE: DR. JAIME VILLARREAL D.D.S.

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	1223G0001X	General Practice Dentistry	22206	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043223910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAIME VILLARREAL D.D.S.

Provider Business Mailing Address
First Line	:	1530 FOREST LN S
Second Line	:	SUITE E
City	:	GARLAND
State	:	TX
Zip	:	75042-7950
Country	:	US
Telephone Number	:	972-485-6100
Fax Number	:	972-485-6111

Provider Business Practice Location Address
First Line	:	1530 FOREST LN
Second Line	:	SUITE E
City	:	GARLAND
State	:	TX
Zip	:	75042-7906
Country	:	US
Telephone Number	:	972-485-6100
Fax Number	:	972-485-6111

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

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	06/11/2010

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Directions to “ DR. JAIME VILLARREAL D.D.S.” Practice Location

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