MEDICARE: ROBERTO L VILLARREALDDS

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	261QD0000X	Dental Clinic/Center	22476	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	:	1528332004
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERTO L VILLARREALDDS

Provider Business Mailing Address
First Line	:	1302 S GENERAL MCMULLEN DR STE 102
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78237-4200
Country	:	US
Telephone Number	:	210-432-7851
Fax Number	:	210-432-1157

Provider Business Practice Location Address
First Line	:	1302 S GENERAL MCMULLEN DR STE 102
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78237-4200
Country	:	US
Telephone Number	:	210-432-7851
Fax Number	:	210-432-1157

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	DR. ROBERTO LUIS VILLARREAL
Credential	:	DDS
Telephone Number	:	210-432-7851

Provider Enumeration Date	:	03/01/2012
Last Update Date	:	03/01/2012

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