Provider Demographics
NPI:1497040455
Name:AVILA, DAIRA M (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAIRA
Middle Name:M
Last Name:AVILA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8868 NW 108TH LN
Mailing Address - Street 2:
Mailing Address - City:HIALEAH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33018-4525
Mailing Address - Country:US
Mailing Address - Phone:786-252-5995
Mailing Address - Fax:
Practice Address - Street 1:4039 13TH ST
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-6772
Practice Address - Country:US
Practice Address - Phone:407-892-1643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-17
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 193181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice