Provider Demographics
NPI:1013216605
Name:VILLALTA, PATRICIA (DMD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:
Last Name:VILLALTA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9131 DOLLANGER CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-4064
Mailing Address - Country:US
Mailing Address - Phone:954-661-8608
Mailing Address - Fax:
Practice Address - Street 1:1645 E HWY 50
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-5199
Practice Address - Country:US
Practice Address - Phone:954-661-8608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-22
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 187111223P0221X
TX294801223P0221X
CO105221223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry