Provider Demographics
NPI:1174677231
Name:VILA, CARLOS ENRIQUE (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:ENRIQUE
Last Name:VILA
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 1:442 MARGO LN
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:PA
Mailing Address - Zip Code:19312-1460
Mailing Address - Country:US
Mailing Address - Phone:610-725-9696
Mailing Address - Fax:610-240-9909
Practice Address - Street 1:195 W LANCASTER AVE
Practice Address - Street 2:STE 1
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1748
Practice Address - Country:US
Practice Address - Phone:610-296-7797
Practice Address - Fax:610-240-9909
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS026265L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist