Provider Demographics
NPI:1831365907
Name:VILLASENOR, MARTHA C (DDS)
Entity type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:C
Last Name:VILLASENOR
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 1:7177 W. GREEN BAY RD.
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-1450
Mailing Address - Country:US
Mailing Address - Phone:414-808-3031
Mailing Address - Fax:
Practice Address - Street 1:7177 W. GREEN BAY RD.
Practice Address - Street 2:7177 W. GREEN BAY RD.
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-1450
Practice Address - Country:US
Practice Address - Phone:414-808-3031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1001046-151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice