Provider Demographics
NPI:1750502365
Name:VILLASENOR, GILBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:GILBERT
Middle Name:
Last Name:VILLASENOR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19301 DEREK WAY
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-1169
Mailing Address - Country:US
Mailing Address - Phone:708-479-8114
Mailing Address - Fax:
Practice Address - Street 1:10522 S. CICERO AVE
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-5200
Practice Address - Country:US
Practice Address - Phone:708-424-1960
Practice Address - Fax:708-424-1027
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice