Provider Demographics
NPI:1104377241
Name:OLIVER S. VILLARUEL, DDS, PLLC
Entity Type:Organization
Organization Name:OLIVER S. VILLARUEL, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:
Authorized Official - First Name:OLIVER
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLARUEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-278-7988
Mailing Address - Street 1:410 WEST FM 544
Mailing Address - Street 2:103
Mailing Address - City:MURPHY
Mailing Address - State:TX
Mailing Address - Zip Code:75094
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:410 WEST FM 544
Practice Address - Street 2:103
Practice Address - City:MURPHY
Practice Address - State:TX
Practice Address - Zip Code:75094
Practice Address - Country:US
Practice Address - Phone:469-278-7988
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-24
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22544261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental