Provider Demographics
NPI:1194938209
Name:VILLELA, BERNARDO ANTONIO (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:BERNARDO
Middle Name:ANTONIO
Last Name:VILLELA
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8500 W FLAGLER ST STE 108A
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-2054
Mailing Address - Country:US
Mailing Address - Phone:305-551-2722
Mailing Address - Fax:305-551-3826
Practice Address - Street 1:8500 W FLAGLER ST STE 108A
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2054
Practice Address - Country:US
Practice Address - Phone:305-551-2722
Practice Address - Fax:305-551-3826
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN99231223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics