Provider Demographics
NPI:1871576181
Name:VILLARREAL, GIL JR (DDS)
Entity type:Individual
Prefix:DR
First Name:GIL
Middle Name:
Last Name:VILLARREAL
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 E RIDGE RD
Mailing Address - Street 2:SUITE 9
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-1527
Mailing Address - Country:US
Mailing Address - Phone:956-631-7177
Mailing Address - Fax:956-631-7168
Practice Address - Street 1:1200 E RIDGE RD
Practice Address - Street 2:SUITE 9
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1527
Practice Address - Country:US
Practice Address - Phone:956-631-7177
Practice Address - Fax:956-631-7168
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-22
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX154631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1372294-10Medicaid
TX137229409Medicaid