Provider Demographics
NPI:1639333479
Name:VILLAGO MARKETPLACE DENTAL CARE PC
Entity Type:Organization
Organization Name:VILLAGO MARKETPLACE DENTAL CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:DELWYN
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:520-374-2225
Mailing Address - Street 1:2876 N PINAL AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85222
Mailing Address - Country:US
Mailing Address - Phone:520-374-2225
Mailing Address - Fax:
Practice Address - Street 1:2876 N PINAL AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85222
Practice Address - Country:US
Practice Address - Phone:520-374-2225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ55941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty