Healthcare Provider Details

I. General information

NPI: 1831015890
Provider Name (Legal Business Name): HECTOR DAVID AVILA DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3004 W 26TH ST
CHICAGO IL
60623-4128
US

IV. Provider business mailing address

4749 S KNOX AVE
CHICAGO IL
60632-4836
US

V. Phone/Fax

Practice location:
  • Phone: 773-231-8000
  • Fax:
Mailing address:
  • Phone: 312-823-4617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019.037226
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: