Provider Demographics
NPI:1104320720
Name:AYZIN, JRONALD MICHAEL (DDS)
Entity type:Individual
Prefix:DR
First Name:JRONALD
Middle Name:MICHAEL
Last Name:AYZIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:RONALD
Other - Middle Name:
Other - Last Name:AYZIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:7 FAENZA
Mailing Address - Street 2:
Mailing Address - City:NEWPORT COAST
Mailing Address - State:CA
Mailing Address - Zip Code:92657-1602
Mailing Address - Country:US
Mailing Address - Phone:949-400-4720
Mailing Address - Fax:
Practice Address - Street 1:24881 ALICIA PKWY STE H
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-4617
Practice Address - Country:US
Practice Address - Phone:949-707-5273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-19
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA1025901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program