Provider Demographics
NPI:1235134032
Name:AVILA, EDUARDO A (DMD, MPH)
Entity Type:Individual
Prefix:DR
First Name:EDUARDO
Middle Name:A
Last Name:AVILA
Suffix:
Gender:M
Credentials:DMD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-17
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD137961223X0400X
FLD161281223X0400X
DC10007831223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics