Provider Demographics
NPI:1851777304
Name:VILLALON, JAMES KELLAN (DDS, MPH)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:KELLAN
Last Name:VILLALON
Suffix:
Gender:M
Credentials:DDS, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 N MAIN ST STE 207
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-2857
Mailing Address - Country:US
Mailing Address - Phone:719-286-0733
Mailing Address - Fax:
Practice Address - Street 1:1225 N MAIN ST STE 207
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-2857
Practice Address - Country:US
Practice Address - Phone:719-286-0733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-07
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT11742122300000X
CO203024122300000X
COGEN.027861941223D0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0004XDental ProvidersDentistDentist Anesthesiologist
No122300000XDental ProvidersDentist