Provider Demographics
NPI:1093899171
Name:VILLA, RODOLFO (DDS)
Entity Type:Individual
Prefix:DR
First Name:RODOLFO
Middle Name:
Last Name:VILLA
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 1:46 INDIAN TRCE
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-4551
Mailing Address - Country:US
Mailing Address - Phone:954-217-9200
Mailing Address - Fax:954-217-9500
Practice Address - Street 1:46 INDIAN TRCE
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-4551
Practice Address - Country:US
Practice Address - Phone:954-217-9200
Practice Address - Fax:954-217-9500
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 136051223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics