Provider Demographics
NPI:1023795929
Name:AYENI, CHRISTIAN-ADEBAYO
Entity type:Individual
Prefix:DR
First Name:CHRISTIAN-ADEBAYO
Middle Name:
Last Name:AYENI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10797 MIDWAY DR
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-2379
Mailing Address - Country:US
Mailing Address - Phone:214-450-1723
Mailing Address - Fax:
Practice Address - Street 1:193 RIVER RD STE 230
Practice Address - Street 2:
Practice Address - City:LISBON
Practice Address - State:CT
Practice Address - Zip Code:06351-3258
Practice Address - Country:US
Practice Address - Phone:860-376-8800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18598331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice