| Doctor Name: | DR. OLMEDO IVAN VILLAVICENCIO |
| NPI Number: | 1013059450 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | D.D.S. |
| License Number: | 0401007760 |
| Business Practice Address: | 7501 Little River Tpke Ste 105 Annandale, VA - 220032923 |
| Business Phone Number: | 7033542878 |
| Business Fax Number: | 7033542712 |
| Mailing Address: | 7501 Little River Tpke Ste 105, ANNANDALE |
| State: | VA |
| Postal Code: | 220032923 |
| Phone Number: | 7033542878 |
| Fax Number: | 7033542712 |
| NPI Enumeration Date: | 02/13/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1223G0001X |
| License Number: | 0401007760 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Dental Providers |
| Taxonomy Classification: | Dentist |
| Taxonomy Specialization: | General Practice |
| Taxonomy Definition: | A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |