Organization
BOCA DENTAL STUDIO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT VILLA DDS (CEO/DENTIST)
(847) 668-3876
Entity
Organization
Contact information
Practice address
1 E DELAWARE PL STE 110, CHICAGO, IL 60611-1449
(847) 668-3876
Mailing address
205 S PEORIA ST APT 1327, CHICAGO, IL 60607-3114
(847) 668-3876
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
261QD0000X
Dental Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1811424450
NPPES
IL
Enumeration date
10/06/2022
Last updated
10/12/2022
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