Hilda Ivelisse Avila – General Practice Dentistry

Key facts

NPI: 1447342134
Entity type: Individual (NPI type 1)
Primary specialty: General Practice Dentistry 1223G0001X
License: 015688 (GA)
Practice address: 3500 Professional Cir
Martinez, GA 30907-8230
Phone: (706) 860-9882
Fax: (706) 860-4740
NPI assigned: Sep 29, 2006
Sex: Female
Sole proprietor: No

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

David Alemar DMD PC General Practice Dentistry · Martinez, GA · NPI 1235837337

NPD GENERAL PRACTICE
Clinica Dental Torres Fernandez LLC Dentist · San Juan, PR · NPI 1710082151

NPD (past) GENERAL PRACTICE

Medicare participation

Medicare fee-for-service enrollment: Enrolled in PR
Eligible to order & refer: Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
I20160414000249	PR	Order and Referring Only - Oral Surgery Practitioner - Oral Surgery	6103124847

National Provider Directory

Medicare enrollment (NPD): Yes

State licenses

License	State	Type	Specialty
015688	GA	MD	General Practice Dentistry

Practice roles

Organization	Specialty	Status	New patients
David Alemar DMD PC	General Practice	Current since Feb 26, 2023	Accepting new patients
Clinica Dental Torres Fernandez LLC	General Practice	Past since May 24, 2020	Accepting new patients

Locations

3500 Professional Cir
Martinez, GA 30907
Phone (706) 860-9882

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
General Practice Dentistry	1223G0001X	2509	PR
General Practice Dentistry	1223G0001X	015688	GA	Yes

Addresses

Primary practice location

3500 Professional Cir
Martinez, GA 30907-8230

Mailing address

3500 Professional Cir
Martinez, GA 30907-8230
Phone (706) 860-9882

Other identifiers

Identifier	Type	State	Issuer
660386268-03	Other	PR	MCS
40157AV	Other	PR	TRIPLE S
100141	Other	PR	CRUZ AZUL
9260215	Other	PR	HUMANA

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Feb 20, 2023.

{
    "created_epoch": "1159488000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676851200000",
    "number": "1447342134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3500 PROFESSIONAL CIR",
            "city": "MARTINEZ",
            "state": "GA",
            "postal_code": "309078230",
            "telephone_number": "706-860-9882",
            "fax_number": "706-860-4740"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3500 PROFESSIONAL CIR",
            "city": "MARTINEZ",
            "state": "GA",
            "postal_code": "309078230",
            "telephone_number": "706-860-9882",
            "fax_number": "706-860-4740"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AVILA",
        "first_name": "HILDA",
        "middle_name": "IVELISSE",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-29",
        "last_updated": "2023-02-20",
        "certification_date": "2023-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "PR",
            "license": "2509",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "015688",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MCS",
            "identifier": "660386268-03",
            "state": "PR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRIPLE S",
            "identifier": "40157AV",
            "state": "PR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CRUZ AZUL",
            "identifier": "100141",
            "state": "PR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HUMANA",
            "identifier": "9260215",
            "state": "PR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Martinez, GA

All providers in Martinez, GA · General Practice Dentistry in Georgia

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 20, 2023. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Order and Referring (CMS).
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.