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General NPI Number Information
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NPI Number | 1417009846
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Entity Type | Organization
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Legal Business Name | GRUPO DENTAL AYALA DEL RIO CSP
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 07/22/2020
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Provider Practice Location Address
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Address Line | M10 AVE. EL CONQUISTADOR VALLE VERDE SUITE 201
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City | FAJARDO
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State | PR
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Zip | 00738-3743
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Country | US
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Telephone | 787-860-4223
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Fax | 787-863-6972
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Provider Business Mailing Address
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Address Line | PO BOX 9150
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City | HUMACAO
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State | PR
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Zip | 00792-9150
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Country | US
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Telephone | 787-860-4223
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JAVIER A AYALA
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Credential | D.M.D.
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Telephone | 787-860-4223
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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