Provider Demographics
NPI:1023094596
Name:DAVILA-PABON, ANGEL (DDS)
Entity type:Individual
Prefix:DR
First Name:ANGEL
Middle Name:
Last Name:DAVILA-PABON
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 1:1479 AVE ASHFORD
Mailing Address - Street 2:COND. CONDADO DEL MAR APT # 410
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-1583
Mailing Address - Country:US
Mailing Address - Phone:787-725-4848
Mailing Address - Fax:
Practice Address - Street 1:250 CALLE DEL PARQUE
Practice Address - Street 2:SUITE 1A
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00912-3200
Practice Address - Country:US
Practice Address - Phone:787-725-4848
Practice Address - Fax:787-725-4848
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-16
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR27291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice