Provider Demographics
NPI:1447342134
Name:AVILA, HILDA IVELISSE (DMD)
Entity type:Individual
Prefix:
First Name:HILDA
Middle Name:IVELISSE
Last Name:AVILA
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 1:3500 PROFESSIONAL CIR
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-8230
Mailing Address - Country:US
Mailing Address - Phone:706-860-9882
Mailing Address - Fax:706-860-4740
Practice Address - Street 1:3500 PROFESSIONAL CIR
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-8230
Practice Address - Country:US
Practice Address - Phone:706-860-9882
Practice Address - Fax:706-860-4740
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR25091223G0001X
GA0156881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR660386268-03OtherMCS
PR40157AVOtherTRIPLE S
PR100141OtherCRUZ AZUL
PR9260215OtherHUMANA