Provider Demographics
NPI:1942406996
Name:VILLASENOR, DELFIN DALE III (DDS)
Entity Type:Individual
Prefix:DR
First Name:DELFIN
Middle Name:DALE
Last Name:VILLASENOR
Suffix:III
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 1:3156 OAK RD APT 216
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94597-7723
Mailing Address - Country:US
Mailing Address - Phone:510-910-9105
Mailing Address - Fax:
Practice Address - Street 1:1479 YGNACIO VALLEY RD STE 107
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2987
Practice Address - Country:US
Practice Address - Phone:925-945-7977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice