Provider Demographics
NPI:1649960741
Name:VILLARREAL, ALBERTO
Entity type:Individual
Prefix:
First Name:ALBERTO
Middle Name:
Last Name:VILLARREAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 ARKANSAS ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77587-4911
Mailing Address - Country:US
Mailing Address - Phone:713-249-4047
Mailing Address - Fax:
Practice Address - Street 1:3510 MAIN ST STE E
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-9568
Practice Address - Country:US
Practice Address - Phone:713-249-4047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-11
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24828124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist