Provider Demographics
NPI:1609856731
Name:AVILLO, ANDREW JAMES (DDS)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:JAMES
Last Name:AVILLO
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:PSC 1003 BOX 9
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:09728
Mailing Address - Country:US
Mailing Address - Phone:011354-425-5230
Mailing Address - Fax:
Practice Address - Street 1:PSC 1003 BOX 9
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09728
Practice Address - Country:US
Practice Address - Phone:011354-425-5230
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS031139L1223G0001X
MD133981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223G0001XDental ProvidersDentistGeneral Practice