Provider Demographics
NPI:1396831681
Name:VILLARREAL, ROBERTO LUIS (DDS)
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:LUIS
Last Name:VILLARREAL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 LAVACA ST
Mailing Address - Street 2:#640
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-3960
Mailing Address - Country:US
Mailing Address - Phone:210-884-0221
Mailing Address - Fax:
Practice Address - Street 1:11130 JOLLYVILLE RD
Practice Address - Street 2:SUITE 1500
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-5593
Practice Address - Country:US
Practice Address - Phone:512-346-8424
Practice Address - Fax:512-346-3848
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX224761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice