Provider Demographics
NPI:1447098348
Name:VILLAMIZAR DUENAS, EMMA VANESSA (DDS)
Entity type:Individual
Prefix:DR
First Name:EMMA
Middle Name:VANESSA
Last Name:VILLAMIZAR DUENAS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 SAN TROPEZ CT
Mailing Address - Street 2:
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-4429
Mailing Address - Country:US
Mailing Address - Phone:949-610-6429
Mailing Address - Fax:
Practice Address - Street 1:805 W LA VETA AVE STE 204
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3929
Practice Address - Country:US
Practice Address - Phone:714-288-8565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-16
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110307122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist