Individual
DR. MICHAEL DAVID VILLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
15406 JEWEL AVE APT 3C, FLUSHING, NY 11367-1846
(347) 552-6661
Mailing address
15406 JEWEL AVE APT 3C, FLUSHING, NY 11367-1846
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
064134
NY
1223P0300X
Periodontics
22DI03015600
NJ
124Q00000X
Dental Hygienist
027079
NY
Other
Enumeration date
08/17/2024
Last updated
08/19/2024
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