Provider Demographics
NPI:1548386543
Name:VILLAR, MARIA GODELIA (DDS)
Entity Type:Individual
Prefix:MISS
First Name:MARIA
Middle Name:GODELIA
Last Name:VILLAR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:MARIA
Other - Middle Name:G
Other - Last Name:VILLAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:848 S ALMADEN AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95110-3056
Mailing Address - Country:US
Mailing Address - Phone:408-298-6411
Mailing Address - Fax:408-298-0464
Practice Address - Street 1:848 S ALMADEN AVE STE 100
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95110-3056
Practice Address - Country:US
Practice Address - Phone:408-221-8068
Practice Address - Fax:408-298-0464
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40754122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB40754OtherDELTA DENTAL STATE GOVERN