Provider Demographics
NPI:1144652892
Name:MICHELLE DAVILA DDS, PC
Entity type:Organization
Organization Name:MICHELLE DAVILA DDS, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVILA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-771-7500
Mailing Address - Street 1:301 W ROCK ISLAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:BOYD
Mailing Address - State:TX
Mailing Address - Zip Code:76023
Mailing Address - Country:US
Mailing Address - Phone:214-771-7500
Mailing Address - Fax:940-433-2233
Practice Address - Street 1:301 W ROCK ISLAND AVENUE
Practice Address - Street 2:
Practice Address - City:BOYD
Practice Address - State:TX
Practice Address - Zip Code:76023
Practice Address - Country:US
Practice Address - Phone:214-771-7500
Practice Address - Fax:940-433-2233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-05
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25817122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty