Provider Demographics
NPI:1538476858
Name:DAVILA, MICHELLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:
Last Name:DAVILA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 W. ROCK ISLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BOYD
Mailing Address - State:TX
Mailing Address - Zip Code:76023
Mailing Address - Country:US
Mailing Address - Phone:615-579-1015
Mailing Address - Fax:940-433-2233
Practice Address - Street 1:301 W. ROCK ISLAND AVENUE
Practice Address - Street 2:
Practice Address - City:BOYD
Practice Address - State:TX
Practice Address - Zip Code:76023
Practice Address - Country:US
Practice Address - Phone:615-579-1015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25817122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist