MEDICARE: DR. HILDA MARIA VILLEGAS 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	122300000X	Dentist	DS037901	PA

General Provider Information

NPI Number	:	1124254099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HILDA MARIA VILLEGAS DMD

Provider Business Mailing Address
First Line	:	22 LIZBETH LN
Second Line	:
City	:	BERWYN
State	:	PA
Zip	:	19312-1210
Country	:	US
Telephone Number	:	610-296-7777
Fax Number	:

Provider Business Practice Location Address
First Line	:	4659 W CHESTER PIKE
Second Line	:
City	:	NEWTOWN SQUARE
State	:	PA
Zip	:	19073-2226
Country	:	US
Telephone Number	:	610-356-5437
Fax Number	:

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

Provider Enumeration Date	:	06/05/2009
Last Update Date	:	06/05/2009

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