Provider Demographics
NPI:1891179362
Name:VILLARREAL, ANTHONY CONNER (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:CONNER
Last Name:VILLARREAL
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 1:1123 S 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-5547
Mailing Address - Country:US
Mailing Address - Phone:956-968-8713
Mailing Address - Fax:956-973-9649
Practice Address - Street 1:1123 S 10TH AVE
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-5547
Practice Address - Country:US
Practice Address - Phone:956-968-8713
Practice Address - Fax:956-973-9649
Is Sole Proprietor?:No
Enumeration Date:2015-07-15
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX312151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice