Provider Demographics
NPI:1063432367
Name:AVILA, ANGELA ANNETTE (DDS)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:ANNETTE
Last Name:AVILA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8300 LIMONITE AVE
Mailing Address - Street 2:STE C
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92509-5174
Mailing Address - Country:US
Mailing Address - Phone:951-361-0443
Mailing Address - Fax:951-685-5098
Practice Address - Street 1:8300 LIMONITE AVE
Practice Address - Street 2:STE C
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92509-5174
Practice Address - Country:US
Practice Address - Phone:951-361-0443
Practice Address - Fax:951-685-5098
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49460122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist