1902936248 NPI number — C. EDGAR DAVILA DDS MS PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902936248 NPI number — C. EDGAR DAVILA DDS MS PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
C. EDGAR DAVILA DDS MS PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
TAMPA ADVANCED DENTAL SOLUTIONS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902936248
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/02/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4712 N ARMENIA AVE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33603-2611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-872-9313
Provider Business Practice Location Address Fax Number:
813-354-9446
Provider Enumeration Date:
03/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DAVILA
Authorized Official First Name:
CHRISTIAN
Authorized Official Middle Name:
EDGAR
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
813-872-9313

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X , with the licence number:  13352 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 763767 . This is a "UNITED CONCORDIA ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1346348166 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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