Healthcare Provider Details

I. General information

NPI: 1700968435
Provider Name (Legal Business Name): JULIAN E. DAVILA D.M.D., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 05/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8140 OAKLANDON RD
INDIANAPOLIS IN
46236-9543
US

IV. Provider business mailing address

8140 OAKLANDON RD
INDIANAPOLIS IN
46236-9543
US

V. Phone/Fax

Practice location:
  • Phone: 317-823-8338
  • Fax: 317-823-8420
Mailing address:
  • Phone: 317-823-8338
  • Fax: 317-823-8420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number12011389A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: