Provider Demographics
NPI:1053512939
Name:AVILA, JOSE L (DDS)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:L
Last Name:AVILA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3070 SW 136TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-6644
Mailing Address - Country:US
Mailing Address - Phone:305-480-0677
Mailing Address - Fax:
Practice Address - Street 1:14586 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33184-3133
Practice Address - Country:US
Practice Address - Phone:305-221-8780
Practice Address - Fax:305-221-0364
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 182041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice