Provider Demographics
NPI:1366966129
Name:MORANTES-VILLALOBOS, ANDRES FELIPE (DDS)
Entity type:Individual
Prefix:DR
First Name:ANDRES
Middle Name:FELIPE
Last Name:MORANTES-VILLALOBOS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11318 VIPOND DR NW
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98329-6934
Mailing Address - Country:US
Mailing Address - Phone:612-483-8450
Mailing Address - Fax:
Practice Address - Street 1:USA DENTAL ACTIVITY
Practice Address - Street 2:BLDG 6-6837 NORMANDY DRIVE, ATTN: CREDENTIALS
Practice Address - City:APO
Practice Address - State:AA
Practice Address - Zip Code:13602-5005
Practice Address - Country:US
Practice Address - Phone:910-396-6602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-02
Last Update Date:2018-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND13829122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist