Provider Demographics
NPI:1396969192
Name:VILLWOCK, ROBERT MELVIN (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:MELVIN
Last Name:VILLWOCK
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 1:1401 KINGSTON TERRACE
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54302-5405
Mailing Address - Country:US
Mailing Address - Phone:920-465-4477
Mailing Address - Fax:920-465-4479
Practice Address - Street 1:1401 KINGSTON TERRACE
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54302-5405
Practice Address - Country:US
Practice Address - Phone:920-465-4477
Practice Address - Fax:920-465-4479
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2519122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist