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General NPI Number Information
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NPI Number | 1144652892
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Entity Type | Organization
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Legal Business Name | MICHELLE DAVILA DDS, PC
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Dates
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Enumeration Date | 08/05/2013
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Last Update Date | 08/05/2013
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Provider Practice Location Address
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Address Line | 301 W ROCK ISLAND AVENUE
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City | BOYD
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State | TX
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Zip | 76023
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Country | US
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Telephone | 214-771-7500
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Fax | 940-433-2233
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Provider Business Mailing Address
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Address Line | 301 W ROCK ISLAND AVENUE
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City | BOYD
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State | TX
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Zip | 76023
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Country | US
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Telephone | 214-771-7500
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Fax | 940-433-2233
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHELLE DAVILA
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Credential | DDS
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Telephone | 214-771-7500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 25817
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License Number State | TX
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