Provider Demographics
NPI:1891206140
Name:MICHAEL S. AYES DDS AND ASSOCIATES PENNSYLVANIA IV,PC
Entity Type:Organization
Organization Name:MICHAEL S. AYES DDS AND ASSOCIATES PENNSYLVANIA IV,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:D
Authorized Official - Last Name:BAALS
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:856-381-7196
Mailing Address - Street 1:201 OLD YORK RD
Mailing Address - Street 2:
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-3707
Mailing Address - Country:US
Mailing Address - Phone:215-576-0421
Mailing Address - Fax:215-576-0816
Practice Address - Street 1:201 OLD YORK RD
Practice Address - Street 2:
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-3707
Practice Address - Country:US
Practice Address - Phone:215-576-0421
Practice Address - Fax:215-576-0816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-13
Last Update Date:2017-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS019098L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty