Provider Demographics
NPI:1144426461
Name:VILLA, HUMBERTO (DMD)
Entity Type:Individual
Prefix:
First Name:HUMBERTO
Middle Name:
Last Name:VILLA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 AVE JOSE DE DIEGO
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612-4383
Mailing Address - Country:US
Mailing Address - Phone:787-879-3620
Mailing Address - Fax:
Practice Address - Street 1:418 AVE JOSE DE DIEGO
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-4383
Practice Address - Country:US
Practice Address - Phone:787-879-3620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR009421223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics