Provider Demographics
NPI:1225404023
Name:G VILLEGAS DDS DENTAL INC
Entity type:Organization
Organization Name:G VILLEGAS DDS DENTAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:ESTELLA
Authorized Official - Last Name:VILLEGAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-648-4769
Mailing Address - Street 1:1126 N FLOWER ST
Mailing Address - Street 2:SUITE #A
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92703-2385
Mailing Address - Country:US
Mailing Address - Phone:657-247-0570
Mailing Address - Fax:657-247-0569
Practice Address - Street 1:1126 N FLOWER ST
Practice Address - Street 2:SUITE #A
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92703-2385
Practice Address - Country:US
Practice Address - Phone:657-247-0570
Practice Address - Fax:657-247-0569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-15
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58271302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1659507440OtherDENTICAL