Provider Demographics
NPI:1912271966
Name:VILLACONN LLC
Entity Type:Organization
Organization Name:VILLACONN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:VILLAFANE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-484-5760
Mailing Address - Street 1:5760 S 86TH ST # 2
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68526-6053
Mailing Address - Country:US
Mailing Address - Phone:402-484-5760
Mailing Address - Fax:402-484-0229
Practice Address - Street 1:5760 S 86TH ST # 2
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68526-6053
Practice Address - Country:US
Practice Address - Phone:402-484-5760
Practice Address - Fax:402-484-0229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-07
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE6696122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty