Provider Demographics
NPI:1386440006
Name:VILLANUEVA, NICOLA J (DDS)
Entity type:Individual
Prefix:
First Name:NICOLA
Middle Name:J
Last Name:VILLANUEVA
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 N 20TH ST APT 329
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68102-4309
Mailing Address - Country:US
Mailing Address - Phone:312-522-3280
Mailing Address - Fax:
Practice Address - Street 1:2006 N ROCK RD STE 300
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:KS
Practice Address - Zip Code:67037-3857
Practice Address - Country:US
Practice Address - Phone:316-416-6057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-22
Last Update Date:2025-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1223G0001X1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice