Provider Demographics
NPI:1184127516
Name:VILLA, ROBERT J (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
Last Name:VILLA
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 1:5471 RFD
Mailing Address - Street 2:
Mailing Address - City:LONG GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60047-8211
Mailing Address - Country:US
Mailing Address - Phone:847-668-3876
Mailing Address - Fax:
Practice Address - Street 1:5471 RFD
Practice Address - Street 2:
Practice Address - City:LONG GROVE
Practice Address - State:IL
Practice Address - Zip Code:60047-8211
Practice Address - Country:US
Practice Address - Phone:847-668-3876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-12
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1001763122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist