Provider Demographics
NPI:1407832157
Name:VILLINES, NATHAN CLARK (DDS)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:CLARK
Last Name:VILLINES
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 1:210 E FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:OK
Mailing Address - Zip Code:73096-5135
Mailing Address - Country:US
Mailing Address - Phone:580-772-2435
Mailing Address - Fax:580-772-2436
Practice Address - Street 1:210 E FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:OK
Practice Address - Zip Code:73096-5135
Practice Address - Country:US
Practice Address - Phone:580-772-2435
Practice Address - Fax:580-772-2436
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK54461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice