Provider Demographics
NPI:1376633727
Name:VILLANUEVA, STEPHANIE RAE (DDS)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:RAE
Last Name:VILLANUEVA
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 1:10333 HOLE AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505-1747
Mailing Address - Country:US
Mailing Address - Phone:951-688-7150
Mailing Address - Fax:
Practice Address - Street 1:10333 HOLE AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-1747
Practice Address - Country:US
Practice Address - Phone:951-688-7150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA547851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice