Provider Demographics
NPI:1043223910
Name:VILLARREAL, JAIME (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAIME
Middle Name:
Last Name:VILLARREAL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 FOREST LN S
Mailing Address - Street 2:SUITE E
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042-7950
Mailing Address - Country:US
Mailing Address - Phone:972-485-6100
Mailing Address - Fax:972-485-6111
Practice Address - Street 1:1530 FOREST LN
Practice Address - Street 2:SUITE E
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-7906
Practice Address - Country:US
Practice Address - Phone:972-485-6100
Practice Address - Fax:972-485-6111
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX222061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX184719601Medicaid