Provider Demographics
NPI:1598370280
Name:VILLARREAL, BRANDON JAMES (DDS)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:JAMES
Last Name:VILLARREAL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 PEARSE DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78415-4717
Mailing Address - Country:US
Mailing Address - Phone:361-288-0033
Mailing Address - Fax:
Practice Address - Street 1:11345 ALAMO RANCH PKWY STE 104
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78253-6442
Practice Address - Country:US
Practice Address - Phone:210-538-2772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX367091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice