Provider Demographics
NPI:1376613042
Name:VILLANUEVA, CHRIS STEVEN (DMD)
Entity Type:Individual
Prefix:MR
First Name:CHRIS
Middle Name:STEVEN
Last Name:VILLANUEVA
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 1:2401 S STEMMONS FWY
Mailing Address - Street 2:#1258
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067
Mailing Address - Country:US
Mailing Address - Phone:214-221-4867
Mailing Address - Fax:972-459-7627
Practice Address - Street 1:2401 S STEMMONS FWY
Practice Address - Street 2:#1258
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067
Practice Address - Country:US
Practice Address - Phone:214-221-4867
Practice Address - Fax:972-459-7627
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21919122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX167418612Medicaid
TX21919Medicaid