Provider Demographics
NPI:1053507996
Name:VILLADA, ALEJANDRA (DDS)
Entity Type:Individual
Prefix:
First Name:ALEJANDRA
Middle Name:
Last Name:VILLADA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17493 W HONEY MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91387
Mailing Address - Country:US
Mailing Address - Phone:818-399-2269
Mailing Address - Fax:818-920-0180
Practice Address - Street 1:8939 WOODMAN AVENUE
Practice Address - Street 2:#1
Practice Address - City:ARLETA
Practice Address - State:CA
Practice Address - Zip Code:91331
Practice Address - Country:US
Practice Address - Phone:818-920-2215
Practice Address - Fax:818-920-0180
Is Sole Proprietor?:No
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA561051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice