Individual
JUAN CARLOS VILLALOBOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MDM
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
10832
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10832
THE KENTUCKY BOARD OF DENTISTRY
KY
Enumeration date
01/13/2023
Last updated
01/13/2023
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