Provider Demographics
NPI:1255860706
Name:VILLARREAL, RUBEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:RUBEN
Middle Name:
Last Name:VILLARREAL
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 1:17631 SW 4TH CT
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-4016
Mailing Address - Country:US
Mailing Address - Phone:305-746-9841
Mailing Address - Fax:
Practice Address - Street 1:2910 N STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33313-1912
Practice Address - Country:US
Practice Address - Phone:954-533-9639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-08
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN22675122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist