Provider Demographics
NPI:1316239486
Name:WOODWARD & VILLAFANE PC
Entity type:Organization
Organization Name:WOODWARD & VILLAFANE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SEC/TREAS.
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:VILLAFANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-223-2139
Mailing Address - Street 1:801 WEST COURT STREET
Mailing Address - Street 2:
Mailing Address - City:BEATRICE
Mailing Address - State:NE
Mailing Address - Zip Code:68310-3577
Mailing Address - Country:US
Mailing Address - Phone:402-223-2139
Mailing Address - Fax:402-223-4348
Practice Address - Street 1:801 WEST COURT STREET
Practice Address - Street 2:
Practice Address - City:BEATRICE
Practice Address - State:NE
Practice Address - Zip Code:68310-3577
Practice Address - Country:US
Practice Address - Phone:402-223-2139
Practice Address - Fax:402-223-4348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-09
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025078900Medicaid