Provider Demographics
NPI:1194279737
Name:JOY, JAYLEEN MARTHA
Entity type:Individual
Prefix:
First Name:JAYLEEN
Middle Name:MARTHA
Last Name:JOY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:495 BRICKELL AVE
Mailing Address - Street 2:922
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33131-2769
Mailing Address - Country:US
Mailing Address - Phone:305-607-4112
Mailing Address - Fax:
Practice Address - Street 1:495 BRICKELL AVE
Practice Address - Street 2:922
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33131-2769
Practice Address - Country:US
Practice Address - Phone:305-607-4112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-11
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 22240122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist