MEDICARE: DR. CHRISTIAN EDGAR DAVILA DDS,MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0700X	Prosthodontics	DN13352	FL
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	DN13352	FL

General Provider Information

NPI Number	:	1346348166
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTIAN EDGAR DAVILA DDS,MS

Provider Business Mailing Address
First Line	:	4712 N ARMENIA AVE
Second Line	:	SUITE 100
City	:	TAMPA
State	:	FL
Zip	:	33603-2611
Country	:	US
Telephone Number	:	813-872-9313
Fax Number	:	813-354-9446

Provider Business Practice Location Address
First Line	:	4712 N ARMENIA AVE
Second Line	:	SUITE 100
City	:	TAMPA
State	:	FL
Zip	:	33603-2611
Country	:	US
Telephone Number	:	813-872-9313
Fax Number	:	813-354-9446

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	01/17/2024

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