Provider Demographics
NPI:1437301744
Name:JOSE VILLA PC
Entity Type:Organization
Organization Name:JOSE VILLA PC
Other - Org Name:FAMILY DENTAL CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:RECEPTIONIST
Authorized Official - Prefix:
Authorized Official - First Name:KEIKO
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-528-0068
Mailing Address - Street 1:1426 W BELMONT AVE
Mailing Address - Street 2:1426 W BELMONT AVE
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-6898
Mailing Address - Country:US
Mailing Address - Phone:773-528-0068
Mailing Address - Fax:
Practice Address - Street 1:1426 W BELMONT AVE
Practice Address - Street 2:#1
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-6898
Practice Address - Country:US
Practice Address - Phone:773-528-0068
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-17
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2019021731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty