Provider Demographics
NPI:1376629576
Name:RIVERA AYALA, JOSE (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:
Last Name:RIVERA AYALA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:JARDINES DE PONCE
Mailing Address - Street 2:B3 CALLE A
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00730-1816
Mailing Address - Country:US
Mailing Address - Phone:787-844-4173
Mailing Address - Fax:787-847-2946
Practice Address - Street 1:23 CALLE BARCELO
Practice Address - Street 2:
Practice Address - City:VILLALBA
Practice Address - State:PR
Practice Address - Zip Code:00766-2230
Practice Address - Country:US
Practice Address - Phone:787-847-4410
Practice Address - Fax:787-847-2946
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice