Provider Demographics
NPI:1760895742
Name:VILLARREAL, CRYSTAL (DDS)
Entity Type:Individual
Prefix:DR
First Name:CRYSTAL
Middle Name:
Last Name:VILLARREAL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2415 E LOS EBANOS BLVD
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521-2303
Mailing Address - Country:US
Mailing Address - Phone:956-572-0049
Mailing Address - Fax:
Practice Address - Street 1:985 S SAM HOUSTON BLVD
Practice Address - Street 2:
Practice Address - City:SAN BENITO
Practice Address - State:TX
Practice Address - Zip Code:78586-3064
Practice Address - Country:US
Practice Address - Phone:956-399-4312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-06
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30016122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist