Provider Demographics
NPI:1427565118
Name:VILLA, RUBEN JESUS (DDS)
Entity Type:Individual
Prefix:DR
First Name:RUBEN
Middle Name:JESUS
Last Name:VILLA
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 1:695 LARKSPUR DR
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-9782
Mailing Address - Country:US
Mailing Address - Phone:209-830-8344
Mailing Address - Fax:
Practice Address - Street 1:95 W 11TH ST STE 202
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-3961
Practice Address - Country:US
Practice Address - Phone:209-229-8108
Practice Address - Fax:209-221-0883
Is Sole Proprietor?:No
Enumeration Date:2018-01-04
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102237122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist