Healthcare Provider Details

I. General information

NPI: 1225339328
Provider Name (Legal Business Name): EDUARDO A. AVILA, DMD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2010
Last Update Date: 11/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11400 ROCKVILLE PIKE STE 805
ROCKVILLE MD
20852-3054
US

IV. Provider business mailing address

11400 ROCKVILLE PIKE STE 805
ROCKVILLE MD
20852-3054
US

V. Phone/Fax

Practice location:
  • Phone: 301-770-3922
  • Fax: 301-770-5105
Mailing address:
  • Phone: 301-770-3922
  • Fax: 301-770-5105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. EDUARDO A. AVILA
Title or Position: ORTHODONTIST
Credential: DMD, MPH
Phone: 301-684-8586