Provider Demographics
NPI:1891423588
Name:VILLABLANCA, LOREN
Entity Type:Individual
Prefix:
First Name:LOREN
Middle Name:
Last Name:VILLABLANCA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2368 W ROUSSEAU ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-4230
Mailing Address - Country:US
Mailing Address - Phone:520-302-7615
Mailing Address - Fax:
Practice Address - Street 1:2368 W ROUSSEAU ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-4230
Practice Address - Country:US
Practice Address - Phone:520-302-7615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-10
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZH010457124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist