Individual
DR. JOHN R. AVILA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
400 TEEGARDEN ST, LA PORTE, IN 46350-3175
(219) 326-0043
(219) 326-8909
Mailing address
2344 CYNTHIA DR, MICHIGAN CITY, IN 46360-9361
(219) 477-6082
(219) 879-2915
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12009519
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100375060
—
IN
Enumeration date
04/04/2007
Last updated
03/08/2021
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