Provider Demographics
NPI:1750633012
Name:DAVILA PEIXOTO, CARLOS (DDS)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:
Last Name:DAVILA PEIXOTO
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 1:20 KEYES DR APT 6
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-8024
Mailing Address - Country:US
Mailing Address - Phone:786-499-9092
Mailing Address - Fax:
Practice Address - Street 1:20 KEYES DR APT 6
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-8024
Practice Address - Country:US
Practice Address - Phone:786-499-9092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-11
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MADL139541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty