Provider Demographics
NPI:1427244102
Name:PADILLA-VILLANUEVA, GABRIEL (DMD)
Entity type:Individual
Prefix:
First Name:GABRIEL
Middle Name:
Last Name:PADILLA-VILLANUEVA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:COND CAPITOLIO PLAZA 100
Mailing Address - Street 2:CALLE DEL MUELLE APT 1505
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00901
Mailing Address - Country:US
Mailing Address - Phone:787-347-4088
Mailing Address - Fax:
Practice Address - Street 1:191 AVE BETANCES
Practice Address - Street 2:URB. HERMANAS DAVILA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-5159
Practice Address - Country:US
Practice Address - Phone:787-798-4083
Practice Address - Fax:787-785-0643
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-17
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR27971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice