Individual
HILDA IVELISSE AVILA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
3500 PROFESSIONAL CIR, MARTINEZ, GA 30907-8230
(706) 860-9882
(706) 860-4740
Mailing address
3500 PROFESSIONAL CIR, MARTINEZ, GA 30907-8230
(706) 860-9882
(706) 860-4740
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
015688
GA
1223G0001X
General Practice Dentistry
2509
PR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100141
CRUZ AZUL
PR
01
—
40157AV
TRIPLE S
PR
01
—
660386268-03
MCS
PR
01
—
9260215
HUMANA
PR
Enumeration date
09/29/2006
Last updated
02/20/2023
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