Provider Demographics
NPI:1619010386
Name:VILLARREAL, MANUEL RICARDO II (DDS)
Entity Type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:RICARDO
Last Name:VILLARREAL
Suffix:II
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:RICK
Other - Middle Name:
Other - Last Name:VILLARREAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:3675 BOCA CHICA BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521-4483
Mailing Address - Country:US
Mailing Address - Phone:956-542-5545
Mailing Address - Fax:956-542-5547
Practice Address - Street 1:3675 BOCA CHICA BLVD
Practice Address - Street 2:STE A
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-4483
Practice Address - Country:US
Practice Address - Phone:956-542-5545
Practice Address - Fax:956-542-5547
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18069122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111136103Medicaid