Provider Demographics
NPI:1295838340
Name:DAVILA-COLLAZO, JOSE A (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:A
Last Name:DAVILA-COLLAZO
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 1:12 BANIC ST
Mailing Address - Street 2:STE 203
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901
Mailing Address - Country:US
Mailing Address - Phone:908-273-2080
Mailing Address - Fax:908-273-2087
Practice Address - Street 1:12 BANIC ST
Practice Address - Street 2:STE 203
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901
Practice Address - Country:US
Practice Address - Phone:908-273-2080
Practice Address - Fax:908-273-2087
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ198681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice