Provider Demographics
NPI:1396100830
Name:AL VILLALOBOS DMD P.A.
Entity type:Organization
Organization Name:AL VILLALOBOS DMD P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:CONRAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-744-0677
Mailing Address - Street 1:1620 N US HIGHWAY 1
Mailing Address - Street 2:SUITE 6
Mailing Address - City:TEQUESTA
Mailing Address - State:FL
Mailing Address - Zip Code:33469-3228
Mailing Address - Country:US
Mailing Address - Phone:561-744-0677
Mailing Address - Fax:561-743-9067
Practice Address - Street 1:1620 N US HIGHWAY 1
Practice Address - Street 2:SUITE 6
Practice Address - City:TEQUESTA
Practice Address - State:FL
Practice Address - Zip Code:33469-3228
Practice Address - Country:US
Practice Address - Phone:561-744-0677
Practice Address - Fax:561-743-9067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-29
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare