Provider Demographics
NPI:1558589721
Name:AVILA, ARMANDO (DDS)
Entity Type:Individual
Prefix:DR
First Name:ARMANDO
Middle Name:
Last Name:AVILA
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 1:6314 MONARCH DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46224-1132
Mailing Address - Country:US
Mailing Address - Phone:317-295-1470
Mailing Address - Fax:317-295-1471
Practice Address - Street 1:4215 N FRANKLIN RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46226-4003
Practice Address - Country:US
Practice Address - Phone:317-890-1127
Practice Address - Fax:317-890-1128
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120092181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100177360AMedicaid