Provider Demographics
NPI:1528332004
Name:ROBERTO L VILLARREALDDS
Entity type:Organization
Organization Name:ROBERTO L VILLARREALDDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:VILLARREAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-432-7851
Mailing Address - Street 1:1302 S GENERAL MCMULLEN DR STE 102
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78237-4200
Mailing Address - Country:US
Mailing Address - Phone:210-432-7851
Mailing Address - Fax:210-432-1157
Practice Address - Street 1:1302 S GENERAL MCMULLEN DR STE 102
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78237-4200
Practice Address - Country:US
Practice Address - Phone:210-432-7851
Practice Address - Fax:210-432-1157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-01
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22476261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX182496301Medicaid