Provider Demographics
NPI:1760556807
Name:VILLAFANE, JUAN A (DDS)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:A
Last Name:VILLAFANE
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 1:801 WEST COURT STREET
Mailing Address - Street 2:
Mailing Address - City:BEATRICE
Mailing Address - State:NE
Mailing Address - Zip Code:68310
Mailing Address - Country:US
Mailing Address - Phone:402-223-2139
Mailing Address - Fax:402-223-4348
Practice Address - Street 1:801 WEST COURT STREET
Practice Address - Street 2:
Practice Address - City:BEATRICE
Practice Address - State:NE
Practice Address - Zip Code:68310
Practice Address - Country:US
Practice Address - Phone:402-223-2139
Practice Address - Fax:402-223-4348
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE43501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025078900Medicaid