Healthcare Provider Details

I. General information

NPI: 1477148302
Provider Name (Legal Business Name): RENEE AYALA LERNER DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2021
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2524 COUNTY ROAD 220
MIDDLEBURG FL
32068-6532
US

IV. Provider business mailing address

3425 HARTLEY RD
JACKSONVILLE FL
32257-6314
US

V. Phone/Fax

Practice location:
  • Phone: 904-890-1939
  • Fax:
Mailing address:
  • Phone: 929-366-2720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN31675
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number062721
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: