Provider Demographics
NPI:1619257581
Name:VILLANUEVA, CARLOS F (DDS, PROSTHODONTIST)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:F
Last Name:VILLANUEVA
Suffix:
Gender:M
Credentials:DDS, PROSTHODONTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15641 SHERIDAN ST STE 400
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33331-3485
Mailing Address - Country:US
Mailing Address - Phone:954-270-7923
Mailing Address - Fax:954-262-7335
Practice Address - Street 1:15641 SHERIDAN ST STE 400
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33331-3485
Practice Address - Country:US
Practice Address - Phone:954-270-7923
Practice Address - Fax:954-262-7335
Is Sole Proprietor?:No
Enumeration Date:2011-08-24
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN203491223G0001X, 1223P0700X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
No1223P0700XDental ProvidersDentistProsthodontics