Provider Demographics
NPI:1780102749
Name:MICHAEL S AYES DDS AND ASSOCIATES PENNSYLVANIA III, PC
Entity type:Organization
Organization Name:MICHAEL S AYES DDS AND ASSOCIATES PENNSYLVANIA III, 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:DEBRA
Authorized Official - Last Name:BAALS
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:856-381-7196
Mailing Address - Street 1:600 W GERMANTOWN PIKE STE 400
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462-1046
Mailing Address - Country:US
Mailing Address - Phone:856-381-7196
Mailing Address - Fax:
Practice Address - Street 1:712A TRENTON RD
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-5956
Practice Address - Country:US
Practice Address - Phone:215-752-5505
Practice Address - Fax:215-752-9342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-30
Last Update Date:2017-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0190987L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty