Provider Demographics
NPI:1417009846
Name:GRUPO DENTAL AYALA DEL RIO CSP
Entity Type:Organization
Organization Name:GRUPO DENTAL AYALA DEL RIO CSP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAVIER
Authorized Official - Middle Name:A
Authorized Official - Last Name:AYALA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-860-4223
Mailing Address - Street 1:PO BOX 9150
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00792-9150
Mailing Address - Country:US
Mailing Address - Phone:787-860-4223
Mailing Address - Fax:
Practice Address - Street 1:M10 AVE. EL CONQUISTADOR VALLE VERDE
Practice Address - Street 2:SUITE 201
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738-3743
Practice Address - Country:US
Practice Address - Phone:787-860-4223
Practice Address - Fax:787-863-6972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty