MEDICARE: DR. MICHELLE T VILLANUEVA DDS

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	D6398	AZ

General Provider Information

NPI Number	:	1366536823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHELLE T VILLANUEVA DDS

Provider Business Mailing Address
First Line	:	21321 E OCOTILLO RD
Second Line	:
City	:	QUEEN CREEK
State	:	AZ
Zip	:	85142-5996
Country	:	US
Telephone Number	:	480-882-9710
Fax Number	:	480-882-9710

Provider Business Practice Location Address
First Line	:	21321 E OCOTILLO RD STE 112
Second Line	:
City	:	QUEEN CREEK
State	:	AZ
Zip	:	85142-5993
Country	:	US
Telephone Number	:	480-882-9710
Fax Number	:	480-882-9706

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

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	04/29/2026

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