Demitri Villarreal, D.D.S.; M.S.

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

23464 Issued in TX

Practice address

2133 Pepperrell St
Lackland AFB, TX 78236-5313

Phone

(210) 292-2558

NPI assigned

May 31, 2007

Last updated

Apr 30, 2018By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Bandera Modern Dentistry, PC

  • Dentist
  • San Antonio, TX
  • NPI 1184981433
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1180569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1525046400000",
    "number": "1588865943",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2133 PEPPERRELL ST",
            "city": "LACKLAND AFB",
            "state": "TX",
            "postal_code": "782365313",
            "telephone_number": "210-292-2558"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2133 PEPPERRELL ST",
            "city": "LACKLAND AFB",
            "state": "TX",
            "postal_code": "782365313",
            "telephone_number": "210-292-2558"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9234 N Loop 1604 W Ste 121",
            "address_purpose": "LOCATION",
            "city": "San Antonio",
            "state": "TX",
            "postal_code": "782492984",
            "country_code": "US",
            "telephone_number": "210-681-1121",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VILLARREAL",
        "first_name": "DEMITRI",
        "credential": "D.D.S.; M.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-31",
        "last_updated": "2018-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "TX",
            "license": "23464",
            "primary": true
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "NV",
            "license": "S4-97C",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "TX",
            "license": "A000986496",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• US Army
• Usaf
• Bernadette Ann Vanness, IDMT
• Gary Vincent Vigil, DDS
• Carlos Villanueva, CRNA
• Melody Vinson
• Michele Terese Vita, DPT, OCS
• Nancy Vogelgesang, PHARMD
• Brooke Mary Wallace, LCSW, BCD
• Stephen Glenn Waller, MD

• Periodontics in Lackland AFB, TX
• Providers in Lackland AFB, TX by specialty
• Periodontics in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.