Healthcare Provider Details

I. General information

NPI: 1417009846
Provider Name (Legal Business Name): GRUPO DENTAL AYALA DEL RIO CSP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 07/22/2020
Certification Date: 07/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

M10 AVE. EL CONQUISTADOR VALLE VERDE SUITE 201
FAJARDO PR
00738-3743
US

IV. Provider business mailing address

PO BOX 9150
HUMACAO PR
00792-9150
US

V. Phone/Fax

Practice location:
  • Phone: 787-860-4223
  • Fax: 787-863-6972
Mailing address:
  • Phone: 787-860-4223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. JAVIER A AYALA
Title or Position: PRESIDENT
Credential: D.M.D.
Phone: 787-860-4223