Provider Demographics
NPI:1750747234
Name:VILLACIS DENTAL CORPORATION
Entity type:Organization
Organization Name:VILLACIS DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:DR
Authorized Official - First Name:SASKIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:VILLACIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-313-5150
Mailing Address - Street 1:520 E. CARSON PLAZA CURT
Mailing Address - Street 2:STE 101
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90746-3844
Mailing Address - Country:US
Mailing Address - Phone:310-313-5150
Mailing Address - Fax:310-313-5154
Practice Address - Street 1:520 E CARSON PLAZA CT
Practice Address - Street 2:STE 101
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746-3289
Practice Address - Country:US
Practice Address - Phone:310-313-5150
Practice Address - Fax:310-313-5154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-13
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41690261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental