Provider Demographics
NPI:1669877031
Name:AYARZAGOITIA, CARYN (DDS)
Entity type:Individual
Prefix:
First Name:CARYN
Middle Name:
Last Name:AYARZAGOITIA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1036 BRENTWOOD PL
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-1612
Mailing Address - Country:US
Mailing Address - Phone:630-440-6910
Mailing Address - Fax:
Practice Address - Street 1:1576 BUTTITTA DR
Practice Address - Street 2:
Practice Address - City:STREAMWOOD
Practice Address - State:IL
Practice Address - Zip Code:60107-2295
Practice Address - Country:US
Practice Address - Phone:630-372-7380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-28
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.029894122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist