Provider Demographics
NPI:1083036776
Name:VILLA, JULIA (DDS)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:VILLA
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 1:3431 BROADWAY ST
Mailing Address - Street 2:SUITE A-7
Mailing Address - City:AMERICAN CANYON
Mailing Address - State:CA
Mailing Address - Zip Code:94503-1228
Mailing Address - Country:US
Mailing Address - Phone:707-557-5057
Mailing Address - Fax:
Practice Address - Street 1:3431 BROADWAY ST
Practice Address - Street 2:SUITE A-7
Practice Address - City:AMERICAN CANYON
Practice Address - State:CA
Practice Address - Zip Code:94503-1228
Practice Address - Country:US
Practice Address - Phone:707-557-5057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-14
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38471122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist