Provider Demographics
NPI:1669516928
Name:VILLARREAL, JOSE LUIS SR (DDS)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:LUIS
Last Name:VILLARREAL
Suffix:SR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5717 N 10TH ST
Mailing Address - Street 2:SUITE #E
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-2611
Mailing Address - Country:US
Mailing Address - Phone:956-618-2881
Mailing Address - Fax:956-618-3118
Practice Address - Street 1:5717 N 10TH ST
Practice Address - Street 2:SUITE #E
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-2611
Practice Address - Country:US
Practice Address - Phone:956-618-2881
Practice Address - Fax:956-618-3118
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX180681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice