Provider Demographics
NPI:1912152414
Name:VILLALON CALLIS PEDIATRIC DENTISTRY & ORTHODONTIC PARTNERSHIP
Entity Type:Organization
Organization Name:VILLALON CALLIS PEDIATRIC DENTISTRY & ORTHODONTIC PARTNERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BEN
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLALON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:713-272-0036
Mailing Address - Street 1:103 FLUOR DANIEL DR
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-3995
Mailing Address - Country:US
Mailing Address - Phone:713-272-0036
Mailing Address - Fax:713-272-7616
Practice Address - Street 1:103 FLUOR DANIEL DR
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3995
Practice Address - Country:US
Practice Address - Phone:713-272-0036
Practice Address - Fax:713-272-7616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-25
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty