DR. Olmedo Ivan Villavicencio, D.D.S.

NPI #1013059450 in Annandale, Virginia

Provider Information

NPI Number: 1013059450
Entity Type: Individual
Name: DR. Olmedo Ivan Villavicencio, D.D.S.
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Dentist - General Practice
Credential: D.D.S.
Enumeration Date: Feb 13, 2007
Last Updated: Jul 8, 2007

Practice Location

Address: 7501 LITTLE RIVER TPKE STE 105
City: Annandale
State: Virginia
ZIP Code: 22003-2923
Phone: (703) 354-2878

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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