Individual
DR. ERIC PHILIP MEDIAVILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
513 KIVA RD, COLORADO SPRINGS, CO 80911-1913
(303) 588-5349
Mailing address
10036 PALISADE RIDGE DR, COLORADO SPRINGS, CO 80920-1491
(303) 588-5349
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
8322
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
79233562
—
CO
Enumeration date
01/31/2007
Last updated
07/08/2007
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