Individual
DR. MARK ALLAN VILLANUEVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
5025 SE 28TH AVE, PORTLAND, OR 97202-4445
(503) 238-4418
Mailing address
9298 SE HAMILTON LN, HAPPY VALLEY, OR 97086-5004
(503) 538-4418
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
59082
CA
1223G0001X
General Practice Dentistry
D9990
OR
Other
Enumeration date
01/23/2010
Last updated
05/08/2015
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