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913 E Warner Rd Gilbert AZ 85296-3078 | |
| (602) 418-1599 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 913 E Warner Rd, Gilbert, Arizona |
| Authorized Official Name and Position | Walter Villanueva (PEDIATRIC DENTIST/OWNER) |
| Authorized Official Contact | 6024181592 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
913 E Warner Rd Gilbert AZ 85296-3078 Ph: (602) 418-1599 | 913 E Warner Rd Gilbert AZ 85296-3078 Ph: (602) 418-1599 |
| NPI Number | 1073895629 |
|---|---|
| Provider Enumeration Date | 09/09/2011 |
| Last Update Date | 09/09/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073895629 | NPI | - | NPPES |
| 436424 | Medicaid | AZ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | D7782 (Arizona) | Primary |
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