Provider Demographics
NPI:1750486403
Name:AVILA, CHARLES JOSEPH (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:JOSEPH
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 1:1038 14TH ST
Mailing Address - Street 2:#7
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-4241
Mailing Address - Country:US
Mailing Address - Phone:562-624-4949
Mailing Address - Fax:562-491-9059
Practice Address - Street 1:1027 LINDEN AVE
Practice Address - Street 2:SUITE C
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-3320
Practice Address - Country:US
Practice Address - Phone:562-624-4949
Practice Address - Fax:562-491-9059
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46166122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist