Provider Demographics
NPI:1063001857
Name:WEST CLAY ORTHODONTICS, LLC.
Entity Type:Organization
Organization Name:WEST CLAY ORTHODONTICS, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:DAVILA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:317-507-9820
Mailing Address - Street 1:2149 GLEBE ST STE 120
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-7294
Mailing Address - Country:US
Mailing Address - Phone:317-795-1829
Mailing Address - Fax:
Practice Address - Street 1:2149 GLEBE ST STE 120
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-7294
Practice Address - Country:US
Practice Address - Phone:317-795-1829
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-15
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty