Provider Demographics
NPI:1215461033
Name:DAVILA, RAUL (DMD)
Entity type:Individual
Prefix:DR
First Name:RAUL
Middle Name:
Last Name:DAVILA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8020 SW 138TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-3042
Mailing Address - Country:US
Mailing Address - Phone:305-546-2200
Mailing Address - Fax:
Practice Address - Street 1:27400 RIVERVIEW CENTER BLVD
Practice Address - Street 2:#8
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-4324
Practice Address - Country:US
Practice Address - Phone:305-546-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-18
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN224401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice