Provider Demographics
NPI:1679620439
Name:VILLAMOR R. USITA, D.D.S., INC.
Entity Type:Organization
Organization Name:VILLAMOR R. USITA, D.D.S., INC.
Other - Org Name:NEW SMILE DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VILLAMOR
Authorized Official - Middle Name:RIALUBIN
Authorized Official - Last Name:USITA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-481-8881
Mailing Address - Street 1:11010 FOOTHILL BLVD
Mailing Address - Street 2:STE. 120
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-7616
Mailing Address - Country:US
Mailing Address - Phone:909-481-8881
Mailing Address - Fax:909-481-7722
Practice Address - Street 1:11010 FOOTHILL BLVD
Practice Address - Street 2:STE. 120
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-7616
Practice Address - Country:US
Practice Address - Phone:909-481-8881
Practice Address - Fax:909-481-7722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA435041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1319695OtherUNITED CONCORDIA PROVIDER
CAB43504-01OtherDENTI-CAL PROVIDER NUMBER