Provider Demographics
NPI:1053828954
Name:BAYOLA PEREZ, AILEMA
Entity Type:Individual
Prefix:
First Name:AILEMA
Middle Name:
Last Name:BAYOLA PEREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12783 FOREST HILL BLVD STE J
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-4772
Mailing Address - Country:US
Mailing Address - Phone:561-244-8382
Mailing Address - Fax:561-244-8366
Practice Address - Street 1:12783 FOREST HILL BLVD STE J
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-4772
Practice Address - Country:US
Practice Address - Phone:561-244-8382
Practice Address - Fax:561-244-8366
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-02
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN231251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice