Provider Demographics
NPI:1225339328
Name:EDUARDO A. AVILA, DMD, LLC
Entity Type:Organization
Organization Name:EDUARDO A. AVILA, DMD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:A
Authorized Official - Last Name:AVILA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MPH
Authorized Official - Phone:301-684-8586
Mailing Address - Street 1:11400 ROCKVILLE PIKE STE 805
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3054
Mailing Address - Country:US
Mailing Address - Phone:301-770-3922
Mailing Address - Fax:301-770-5105
Practice Address - Street 1:11400 ROCKVILLE PIKE STE 805
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3054
Practice Address - Country:US
Practice Address - Phone:301-770-3922
Practice Address - Fax:301-770-5105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-06
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty