Individual
JOSE A VILLANUEVA IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
801 S PAULINA ST, CHICAGO, IL 60612-7210
(312) 996-7555
Mailing address
470 PFINGSTEN RD, NORTHBROOK, IL 60062-2506
(847) 208-4706
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1002599-15
WI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
10/29/2020
Last updated
07/09/2021
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