Provider Demographics
NPI:1245963834
Name:AVILA PORTAL, AILYN (DMD)
Entity type:Individual
Prefix:DR
First Name:AILYN
Middle Name:
Last Name:AVILA PORTAL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 NE 1ST AVE APT H1401
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-4262
Mailing Address - Country:US
Mailing Address - Phone:305-801-5277
Mailing Address - Fax:
Practice Address - Street 1:2340 CORAL WAY
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145-3511
Practice Address - Country:US
Practice Address - Phone:305-856-1178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-01
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN27041122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist