Provider Demographics
NPI:1619081114
Name:AVILES, RENE J (DMD)
Entity Type:Individual
Prefix:DR
First Name:RENE
Middle Name:J
Last Name:AVILES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:870 SW MARTIN DOWNS BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-2855
Mailing Address - Country:US
Mailing Address - Phone:772-283-6881
Mailing Address - Fax:772-283-6362
Practice Address - Street 1:870 SW MARTIN DOWNS BLVD STE 1
Practice Address - Street 2:
Practice Address - City:PALM CITY
Practice Address - State:FL
Practice Address - Zip Code:34990-2855
Practice Address - Country:US
Practice Address - Phone:772-283-6881
Practice Address - Fax:772-283-6362
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN145241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice