Eric Philip Mediavilla, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

8322 Issued in CO

Practice address

513 Kiva Rd
Colorado Springs, CO 80911-1913

Phone

(303) 588-5349

NPI assigned

Jan 31, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1518004274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10036 PALISADE RIDGE DR",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809201491",
            "telephone_number": "303-588-5349"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "513 KIVA RD",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809111913",
            "telephone_number": "303-588-5349"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDIAVILLA",
        "first_name": "ERIC",
        "middle_name": "PHILIP",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-31",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CO",
            "license": "8322",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "79233562",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Med-Trans Corporation
• Medco Care Transportation LLC
• Ricky Medel, M.D.
• Kaylin Medellin
• Medevals of Colorado, Inc.
• Laurie Marguerite Mediavilla, P.A.-C
• Medicaid Dental Home
• Medicaid Management Inc
• Medical Recording Industry
• Medical Restoration Centers, LLC

• General Practice Dentistry in Colorado Springs, CO
• Providers in Colorado Springs, CO by specialty
• General Practice Dentistry in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.