Individual
DEMITRI VILLARREAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.; M.S.
Contact information
Practice address
2133 PEPPERRELL ST, LACKLAND AFB, TX 78236-5313
(210) 292-2558
Mailing address
2133 PEPPERRELL ST, LACKLAND AFB, TX 78236-5313
(210) 292-2558
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
23464
TX
1223P0300X
Periodontics
S4-97C
NV
390200000X
Student in an Organized Health Care Education/Training Program
A000986496
TX
Other
Enumeration date
05/31/2007
Last updated
04/30/2018
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