Provider Demographics
NPI:1538185764
Name:VILLAREAL, DENNIS T (MD)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:T
Last Name:VILLAREAL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:C B 8031
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-286-2715
Mailing Address - Fax:314-286-2701
Practice Address - Street 1:4488 FOREST PARK AVE
Practice Address - Street 2:STE 201
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-2215
Practice Address - Country:US
Practice Address - Phone:314-286-2715
Practice Address - Fax:314-286-2701
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2009-01-28
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Provider Licenses
StateLicense IDTaxonomies
MO102107207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208688002Medicaid
MO208688002Medicaid
008710183Medicare PIN
380000881Medicare PIN
F74952Medicare UPIN