Provider Demographics
NPI:1306831474
Name:DAVILA, JOSE L (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:L
Last Name:DAVILA
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 1:8115 NW 236TH ST
Mailing Address - Street 2:
Mailing Address - City:ALACHUA
Mailing Address - State:FL
Mailing Address - Zip Code:32615-7146
Mailing Address - Country:US
Mailing Address - Phone:352-377-8678
Mailing Address - Fax:352-373-9050
Practice Address - Street 1:4001 W NEWBERRY RD
Practice Address - Street 2:SUITE B4
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-2392
Practice Address - Country:US
Practice Address - Phone:352-377-8678
Practice Address - Fax:352-373-9050
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-15
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00117941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice