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General NPI Number Information
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NPI Number | 1740835883
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Entity Type | Individual
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Provider Name | CARLOS ELIAS VILLACIS DDS
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Gender | Male
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Dates
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Enumeration Date | 08/06/2019
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Last Update Date | 08/15/2019
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Provider Practice Location Address
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Address Line | 6105 HARFORD RD
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City | BALTIMORE
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State | MD
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Zip | 21214-1312
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Country | US
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Telephone | 410-254-5437
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Fax |
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Provider Business Mailing Address
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Address Line | 1211 S CONKLING ST APT 146
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City | BALTIMORE
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State | MD
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Zip | 21224-5342
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Country | US
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Telephone | 786-566-8557
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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 | DN24460
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 17083
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License Number State | MD
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