Provider Demographics
NPI:1275174799
Name:AYRES, DEBORA L (DDS)
Entity Type:Individual
Prefix:DR
First Name:DEBORA
Middle Name:L
Last Name:AYRES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 RANCH ROAD 620 S STE 106
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78738-6311
Mailing Address - Country:US
Mailing Address - Phone:512-263-3330
Mailing Address - Fax:
Practice Address - Street 1:3900 RANCH ROAD 620 S STE 106
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78738-6311
Practice Address - Country:US
Practice Address - Phone:512-263-3330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-06
Last Update Date:2020-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX356761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice