Provider Demographics
NPI:1053973602
Name:AYALA, AJA DINORAH (DDS)
Entity type:Individual
Prefix:DR
First Name:AJA
Middle Name:DINORAH
Last Name:AYALA
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 1:90 SW 3RD ST APT 2308
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33130-4023
Mailing Address - Country:US
Mailing Address - Phone:772-214-9315
Mailing Address - Fax:
Practice Address - Street 1:12404 W DIXIE HWY
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-5430
Practice Address - Country:US
Practice Address - Phone:305-893-4801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-03
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN246211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice