Organization
KIDIATRIC DENTISTRY, PLLC
Active
Other names
Kidiatric Dentistry, PLLC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WALTER VILLANUEVA D.D.S. (PEDIATRIC DENTIST/OWNER)
(602) 418-1592
Entity
Organization
Contact information
Practice address
913 E WARNER RD, GILBERT, AZ 85296-3078
(602) 418-1599
Mailing address
913 E WARNER RD, GILBERT, AZ 85296-3078
(602) 418-1599
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
D7782
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
436424
—
AZ
Enumeration date
09/09/2011
Last updated
09/09/2011
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