Provider Demographics
NPI:1083095079
Name:ARCILA, PAOLA ANDREA (DDS)
Entity Type:Individual
Prefix:
First Name:PAOLA
Middle Name:ANDREA
Last Name:ARCILA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9605 RUBICON TRL
Mailing Address - Street 2:
Mailing Address - City:OAK POINT
Mailing Address - State:TX
Mailing Address - Zip Code:75068-0800
Mailing Address - Country:US
Mailing Address - Phone:940-600-7503
Mailing Address - Fax:
Practice Address - Street 1:200 E SOUTHLAKE BLVD
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6238
Practice Address - Country:US
Practice Address - Phone:817-481-7999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-15
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX309931223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice