Provider Demographics
NPI:1417437781
Name:VILLAMIL, ALEJANDRO (DDS)
Entity Type:Individual
Prefix:
First Name:ALEJANDRO
Middle Name:
Last Name:VILLAMIL
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 1:1210 S LAMAR ST APT 1132
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75215-1013
Mailing Address - Country:US
Mailing Address - Phone:361-442-9302
Mailing Address - Fax:
Practice Address - Street 1:355 E WESTCHESTER PKWY STE 250
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-2846
Practice Address - Country:US
Practice Address - Phone:972-546-3888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX335041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty