Provider Demographics
NPI:1831652411
Name:VILLAVICENCIO, YAMILE (DDS)
Entity Type:Individual
Prefix:DR
First Name:YAMILE
Middle Name:
Last Name:VILLAVICENCIO
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 1:1845 NW 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33993-2931
Mailing Address - Country:US
Mailing Address - Phone:239-233-4531
Mailing Address - Fax:
Practice Address - Street 1:4125 CLEVELAND AVE STE 1430
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-9073
Practice Address - Country:US
Practice Address - Phone:239-939-9050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-10
Last Update Date:2021-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN26353122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist