Provider Demographics
NPI:1538214358
Name:VILLATE MENDOZA, CAROLINA ESCARO (DMD)
Entity type:Individual
Prefix:DR
First Name:CAROLINA
Middle Name:ESCARO
Last Name:VILLATE MENDOZA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:CAROLINA
Other - Middle Name:ESCARO
Other - Last Name:VILLATE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:27225 CAMP PLENTY RD
Mailing Address - Street 2:#9
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91351
Mailing Address - Country:US
Mailing Address - Phone:661-251-4672
Mailing Address - Fax:661-251-0348
Practice Address - Street 1:27225 CAMP PLENTY RD
Practice Address - Street 2:SUITE 9
Practice Address - City:CANYON COUNTRY
Practice Address - State:CA
Practice Address - Zip Code:91351
Practice Address - Country:US
Practice Address - Phone:661-251-4672
Practice Address - Fax:661-251-0348
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA331831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice