MEDICARE: MISS MARIA GODELIA VILLAR 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	122300000X	Dentist	40754	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	B40754	OTHER	CA	DELTA DENTAL STATE GOVERN

General Provider Information

NPI Number	:	1548386543
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MARIA GODELIA VILLAR D.D.S.

Provider Business Mailing Address
First Line	:	848 S ALMADEN AVE STE 100
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95110-3056
Country	:	US
Telephone Number	:	408-298-6411
Fax Number	:	408-298-0464

Provider Business Practice Location Address
First Line	:	848 S ALMADEN AVE STE 100
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95110-3056
Country	:	US
Telephone Number	:	408-221-8068
Fax Number	:	408-298-0464

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

Provider Enumeration Date	:	03/21/2007
Last Update Date	:	10/23/2020

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Directions to “ MISS MARIA GODELIA VILLAR D.D.S.” Practice Location

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