Provider Demographics
NPI:1437392701
Name:BROYLES, AIME (DDS)
Entity Type:Individual
Prefix:
First Name:AIME
Middle Name:
Last Name:BROYLES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:AIME
Other - Middle Name:
Other - Last Name:BROYLES-MAYUGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:680 SE BAYBERRY LN
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063-4386
Mailing Address - Country:US
Mailing Address - Phone:816-525-5257
Mailing Address - Fax:816-525-6050
Practice Address - Street 1:680 SE BAYBERRY LN
Practice Address - Street 2:SUITE 105
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063-4386
Practice Address - Country:US
Practice Address - Phone:816-525-5257
Practice Address - Fax:816-525-6050
Is Sole Proprietor?:No
Enumeration Date:2009-04-15
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS69701223G0001X
MO20070372341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice