Basic Information
| Provider Information | |||||||||
| NPI: | 1619257581 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VILLANUEVA | ||||||||
| FirstName: | CARLOS | ||||||||
| MiddleName: | F | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DDS, PROSTHODONTIST | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15641 SHERIDAN ST STE 400 | ||||||||
| Address2: | |||||||||
| City: | DAVIE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333313485 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9542707923 | ||||||||
| FaxNumber: | 9542627335 | ||||||||
| Practice Location | |||||||||
| Address1: | 15641 SHERIDAN ST STE 400 | ||||||||
| Address2: | |||||||||
| City: | DAVIE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333313485 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9542707923 | ||||||||
| FaxNumber: | 9542627335 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2011 | ||||||||
| LastUpdateDate: | 01/14/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | DN20349 | FL | N | Dental Providers | Dentist | General Practice | 1223P0700X | DN20349 | FL | N | Dental Providers | Dentist | Prosthodontics | 122300000X | DN20349 | FL | Y | Dental Providers | Dentist |
No ID Information.