Provider Demographics
NPI:1679654644
Name:LAYNE, JERRY MARSHAL (MD, DDS)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:MARSHAL
Last Name:LAYNE
Suffix:
Gender:M
Credentials:MD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 SAN REMO AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-3043
Mailing Address - Country:US
Mailing Address - Phone:305-667-1191
Mailing Address - Fax:
Practice Address - Street 1:7231 SW 63RD AVE
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4809
Practice Address - Country:US
Practice Address - Phone:305-667-1191
Practice Address - Fax:305-667-2712
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN11101223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery