Provider Demographics
NPI:1043095086
Name:PVR DENTAL SERVICES, LLC
Entity Type:Organization
Organization Name:PVR DENTAL SERVICES, LLC
Other - Org Name:EVOLUTION ORTHODONTICS & PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RUBEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:VILORIA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-859-0539
Mailing Address - Street 1:1480 NW NORTH RIVER DR # E2305
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-2867
Mailing Address - Country:US
Mailing Address - Phone:305-859-0539
Mailing Address - Fax:
Practice Address - Street 1:7875 SW 104TH ST STE 100
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-2642
Practice Address - Country:US
Practice Address - Phone:646-305-7086
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-28
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty