Provider Demographics
NPI:1902936248
Name:C. EDGAR DAVILA DDS MS PA
Entity Type:Organization
Organization Name:C. EDGAR DAVILA DDS MS PA
Other - Org Name:TAMPA ADVANCED DENTAL SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:EDGAR
Authorized Official - Last Name:DAVILA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:813-872-9313
Mailing Address - Street 1:4712 N ARMENIA AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-2611
Mailing Address - Country:US
Mailing Address - Phone:813-872-9313
Mailing Address - Fax:813-354-9446
Practice Address - Street 1:4712 N ARMENIA AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-2611
Practice Address - Country:US
Practice Address - Phone:813-872-9313
Practice Address - Fax:813-354-9446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL133521223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL763767OtherUNITED CONCORDIA ID
FL1346348166OtherINDIVIDUAL NPI
FLU48154Medicare UPIN
FL69487Medicare ID - Type Unspecified