Provider Demographics
NPI:1689682684
Name:VILLA, LUCY (DMD)
Entity Type:Individual
Prefix:DR
First Name:LUCY
Middle Name:
Last Name:VILLA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 OVINGTON AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209
Mailing Address - Country:US
Mailing Address - Phone:718-285-6039
Mailing Address - Fax:718-285-3518
Practice Address - Street 1:355 OVINGTON AVE
Practice Address - Street 2:STE 101
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209
Practice Address - Country:US
Practice Address - Phone:718-285-6039
Practice Address - Fax:718-285-3518
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI0202081223P0300X
CO91181223P0300X
NY04932911223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9118Medicare UPIN