Provider Demographics
NPI:1477172369
Name:DAVILA, ANDRES (DMD)
Entity type:Individual
Prefix:DR
First Name:ANDRES
Middle Name:
Last Name:DAVILA
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 1:1514 ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-1304
Mailing Address - Country:US
Mailing Address - Phone:708-268-3431
Mailing Address - Fax:
Practice Address - Street 1:1514 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-1304
Practice Address - Country:US
Practice Address - Phone:708-268-3431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-10
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019034411122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty