Individual
JUAN CARLOS VILLALOBOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MDM
Contact information
Practice address
501 S PRESTON ST, LOUISVILLE, KY 40202-1701
(502) 852-7903
Mailing address
1500 RIVER SHORE DR APT 402, LOUISVILLE, KY 40206-2795
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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