Provider Demographics
NPI:1508096793
Name:URIBE, IRMA VILLANUEVA (RDH,BS)
Entity Type:Individual
Prefix:MISS
First Name:IRMA
Middle Name:VILLANUEVA
Last Name:URIBE
Suffix:
Gender:F
Credentials:RDH,BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9200 WHITE SETTLEMENT RD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76108-2028
Mailing Address - Country:US
Mailing Address - Phone:817-246-2721
Mailing Address - Fax:
Practice Address - Street 1:9200 WHITE SETTLEMENT RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76108-2028
Practice Address - Country:US
Practice Address - Phone:817-246-2721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-22
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12769124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist