Provider Demographics
NPI:1366456402
Name:VILLARREAL, MARIA (DDS)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:VILLARREAL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3750 COMMERCIAL AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78221-3117
Mailing Address - Country:US
Mailing Address - Phone:210-922-7000
Mailing Address - Fax:210-637-2484
Practice Address - Street 1:5542 WALZEM RD
Practice Address - Street 2:
Practice Address - City:WINDCREST
Practice Address - State:TX
Practice Address - Zip Code:78218-2103
Practice Address - Country:US
Practice Address - Phone:210-922-7000
Practice Address - Fax:210-637-2484
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX224591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX192084502Medicaid
TX89D515OtherBCBS
TXBV9514539OtherDEA REGISTRATION
TXX0142946OtherDPS REGISTRATION
TXBV9514539OtherDEA REGISTRATION