Provider Demographics
NPI:1346556198
Name:OFELIA V. VILLANUEVA D.M.D. L.L.C
Entity Type:Organization
Organization Name:OFELIA V. VILLANUEVA D.M.D. L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:OFELIA
Authorized Official - Middle Name:VELUZ
Authorized Official - Last Name:VILLANUEVA
Authorized Official - Suffix:
Authorized Official - Credentials:6173284646
Authorized Official - Phone:617-328-4646
Mailing Address - Street 1:339 HANCOCK ST
Mailing Address - Street 2:
Mailing Address - City:NORTH QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02171-2438
Mailing Address - Country:US
Mailing Address - Phone:617-328-4646
Mailing Address - Fax:617-328-4646
Practice Address - Street 1:339 HANCOCK ST
Practice Address - Street 2:
Practice Address - City:NORTH QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02171-2438
Practice Address - Country:US
Practice Address - Phone:617-328-4646
Practice Address - Fax:617-328-4646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-30
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA178071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA11001108AMedicaid