Provider Demographics
NPI:1881810836
Name:VILLAMAR, MARITZA ALEXANDRA (DDS)
Entity type:Individual
Prefix:DR
First Name:MARITZA
Middle Name:ALEXANDRA
Last Name:VILLAMAR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 E 12TH ST
Mailing Address - Street 2:SUITE #301
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-4403
Mailing Address - Country:US
Mailing Address - Phone:646-638-4184
Mailing Address - Fax:
Practice Address - Street 1:24 E 12TH ST
Practice Address - Street 2:SUITE #301
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4403
Practice Address - Country:US
Practice Address - Phone:646-638-4184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0456441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice