Provider Demographics
NPI:1437374873
Name:AYALA-ORANTES, EDMUNDO JOSE (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDMUNDO
Middle Name:JOSE
Last Name:AYALA-ORANTES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20109 SHERMAN WAY
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:CA
Mailing Address - Zip Code:91306-3206
Mailing Address - Country:US
Mailing Address - Phone:818-993-4284
Mailing Address - Fax:818-993-4265
Practice Address - Street 1:20109 SHERMAN WAY
Practice Address - Street 2:
Practice Address - City:WINNETKA
Practice Address - State:CA
Practice Address - Zip Code:91306-3206
Practice Address - Country:US
Practice Address - Phone:818-993-4284
Practice Address - Fax:818-993-4265
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50205122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist