Provider Demographics
NPI:1023342151
Name:VILLARREAL, MARIANELA (DDS)
Entity type:Individual
Prefix:
First Name:MARIANELA
Middle Name:
Last Name:VILLARREAL
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 1:16650 HUEBNER RD APT 1124
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78248-2318
Mailing Address - Country:US
Mailing Address - Phone:585-732-1513
Mailing Address - Fax:
Practice Address - Street 1:7703 FLOYD CURL DR
Practice Address - Street 2:UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3901
Practice Address - Country:US
Practice Address - Phone:210-567-3648
Practice Address - Fax:210-567-6376
Is Sole Proprietor?:No
Enumeration Date:2009-09-22
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF-264011223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics