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General NPI Number Information
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NPI Number | 1245963834
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Entity Type | Individual
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Provider Name | AILYN AVILA PORTAL DMD
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Gender | Female
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Dates
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Enumeration Date | 07/01/2022
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Last Update Date | 02/12/2024
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Provider Practice Location Address
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Address Line | 2340 CORAL WAY
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City | MIAMI
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State | FL
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Zip | 33145-3511
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Country | US
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Telephone | 305-856-1178
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Fax |
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Provider Business Mailing Address
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Address Line | 3301 NE 1ST AVE APT H1401
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City | MIAMI
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State | FL
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Zip | 33137-4262
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Country | US
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Telephone | 305-801-5277
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | DN27041
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License Number State | FL
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