MEDICARE: DR. RUBEN VILLARREAL 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	DN22675	FL

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	:	1255860706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUBEN VILLARREAL DMD

Provider Business Mailing Address
First Line	:	17631 SW 4TH CT
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33029-4016
Country	:	US
Telephone Number	:	305-746-9841
Fax Number	:

Provider Business Practice Location Address
First Line	:	2910 N STATE ROAD 7
Second Line	:
City	:	LAUDERDALE LAKES
State	:	FL
Zip	:	33313-1912
Country	:	US
Telephone Number	:	954-533-9639
Fax Number	:

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

Provider Enumeration Date	:	06/08/2017
Last Update Date	:	02/14/2023

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