Provider Demographics
NPI:1396756177
Name:VILLA, RICHARD HENRY (DMD)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:HENRY
Last Name:VILLA
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Gender:M
Credentials:DMD
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Mailing Address - Street 1:10120 WEST BROAD STREET
Mailing Address - Street 2:SUITE L
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060
Mailing Address - Country:US
Mailing Address - Phone:804-747-0137
Mailing Address - Fax:804-747-5251
Practice Address - Street 1:10120 WEST BROAD STREET
Practice Address - Street 2:SUITE L
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060
Practice Address - Country:US
Practice Address - Phone:804-747-0137
Practice Address - Fax:804-747-5251
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0401008076122300000X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics