Provider Demographics
NPI:1396710695
Name:VILLANUEVA, JOSE RUIZ III (DMD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:RUIZ
Last Name:VILLANUEVA
Suffix:III
Gender:M
Credentials:DMD
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Other - Credentials:
Mailing Address - Street 1:UNIT 26610
Mailing Address - Street 2:BAVARIA DENTAL ACTIVITY CREDENTIALS OFFICE
Mailing Address - City:APO AE
Mailing Address - State:NY
Mailing Address - Zip Code:09244
Mailing Address - Country:US
Mailing Address - Phone:931-804-3933
Mailing Address - Fax:031-804-2524
Practice Address - Street 1:UNIT 26610
Practice Address - Street 2:BAVARIA DENTAL ACTIVITY CREDENTIALS OFFICE
Practice Address - City:APO AE
Practice Address - State:NY
Practice Address - Zip Code:09244
Practice Address - Country:US
Practice Address - Phone:931-804-3933
Practice Address - Fax:031-804-2524
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HIDT18621223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery