Provider Demographics
NPI:1043465743
Name:VILLASENOR DENTAL CARE, P. C.
Entity Type:Organization
Organization Name:VILLASENOR DENTAL CARE, P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:CATALINA
Authorized Official - Last Name:VILLASENOR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-442-5227
Mailing Address - Street 1:8711 W. CERMAK RD. SUITE 1
Mailing Address - Street 2:P.O. BOX 1155
Mailing Address - City:NORTH RIVERSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60546
Mailing Address - Country:US
Mailing Address - Phone:708-442-5227
Mailing Address - Fax:708-442-0420
Practice Address - Street 1:8711 W. CERMAK RD.
Practice Address - Street 2:SUITE 1
Practice Address - City:NORTH RIVERSIDE
Practice Address - State:IL
Practice Address - Zip Code:60546
Practice Address - Country:US
Practice Address - Phone:708-442-5227
Practice Address - Fax:708-442-0420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-21
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty