Provider Demographics
NPI:1558750919
Name:VILLARICA, HANSEL MA. G (DMD)
Entity Type:Individual
Prefix:
First Name:HANSEL MA.
Middle Name:G
Last Name:VILLARICA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:FIRST STREET FAGAALU
Mailing Address - Street 2:PETESA
Mailing Address - City:PAGO PAGO
Mailing Address - State:AS
Mailing Address - Zip Code:96799-4168
Mailing Address - Country:US
Mailing Address - Phone:684-699-6380
Mailing Address - Fax:684-699-6374
Practice Address - Street 1:FIRST STREET FAGAALU
Practice Address - Street 2:PETESA ROAD
Practice Address - City:PAGO PAGO
Practice Address - State:AS
Practice Address - Zip Code:96799-4168
Practice Address - Country:US
Practice Address - Phone:684-699-6380
Practice Address - Fax:684-699-6374
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-22
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AS2026-C1223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health