Provider Demographics
NPI:1699288548
Name:VILLARREAL, KAYLA (RDH)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:VILLARREAL
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57418 COUNTY ROAD 681 STE A
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49057-9422
Mailing Address - Country:US
Mailing Address - Phone:269-621-3143
Mailing Address - Fax:
Practice Address - Street 1:57418 COUNTY ROAD 681 STE A
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:MI
Practice Address - Zip Code:49057-9422
Practice Address - Country:US
Practice Address - Phone:269-621-3143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-14
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2902017359124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist