Provider Demographics
NPI:1467459586
Name:AYALA, JAVIER A (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAVIER
Middle Name:A
Last Name: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: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:787-863-6972
Practice Address - Street 1:M10 AVE CONQUISTADOR VALLE VERDE
Practice Address - Street 2:PLAZA DEL RIO SUITE 201
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738
Practice Address - Country:US
Practice Address - Phone:787-860-4223
Practice Address - Fax:787-863-6972
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR25631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice