Provider Demographics
NPI:1841771441
Name:IDILBI, AYLA
Entity Type:Individual
Prefix:
First Name:AYLA
Middle Name:
Last Name:IDILBI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15918 SIGHT SCAPE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78255-3322
Mailing Address - Country:US
Mailing Address - Phone:904-728-2423
Mailing Address - Fax:
Practice Address - Street 1:9820 POTRANCO RD STE 106
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-9627
Practice Address - Country:US
Practice Address - Phone:210-298-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX345751223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics