Provider Demographics
NPI:1225174352
Name:GABRIEL L VILLENA DDS PA
Entity Type:Organization
Organization Name:GABRIEL L VILLENA DDS PA
Other - Org Name:RESTORATIVE & PROSTHETIC DENTISTRY
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT PROSTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:LIRA
Authorized Official - Last Name:VILLENA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-786-6363
Mailing Address - Street 1:811 SPRING FOREST ROAD
Mailing Address - Street 2:SUITE 1400
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-9145
Mailing Address - Country:US
Mailing Address - Phone:919-846-6363
Mailing Address - Fax:919-876-4768
Practice Address - Street 1:811 SPRING FOREST ROAD
Practice Address - Street 2:SUITE 1400
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-9145
Practice Address - Country:US
Practice Address - Phone:919-846-6363
Practice Address - Fax:919-876-4768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6391122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty