MEDICARE: CARLOS ELIAS VILLACIS DDS

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	122300000X	Dentist	DN24460	FL
2	122300000X	Dentist	17083	MD

General Provider Information

NPI Number	:	1740835883
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLOS ELIAS VILLACIS DDS

Provider Business Mailing Address
First Line	:	6450 W 21ST CT STE 300
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33016-3943
Country	:	US
Telephone Number	:	786-566-8557
Fax Number	:

Provider Business Practice Location Address
First Line	:	6450 W 21ST CT STE 300
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33016-3943
Country	:	US
Telephone Number	:	786-566-8557
Fax Number	:

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

Provider Enumeration Date	:	08/06/2019
Last Update Date	:	05/26/2026

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