Provider Demographics
NPI:1518057488
Name:JUAN D. VILLARRREAL, DDS, SERIES PLLC
Entity Type:Organization
Organization Name:JUAN D. VILLARRREAL, DDS, SERIES PLLC
Other - Org Name:HARLINGEN FAMILY DENTISTRY GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:VILLARREAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:956-428-5322
Mailing Address - Street 1:1214 DIXIELAND RD
Mailing Address - Street 2:SUITE #4
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78552-3351
Mailing Address - Country:US
Mailing Address - Phone:956-428-5322
Mailing Address - Fax:956-428-7986
Practice Address - Street 1:1214 DIXIELAND RD
Practice Address - Street 2:SUITE #4
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78552-3351
Practice Address - Country:US
Practice Address - Phone:956-428-5322
Practice Address - Fax:956-428-7986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG6021001OtherCHIPS
TX00B60GOtherBLUE CROSS BLUE SHIELD
TX009647101Medicaid