Provider Demographics
NPI:1386956233
Name:JOHN R. AYRE, JR. DDS PC
Entity type:Organization
Organization Name:JOHN R. AYRE, JR. DDS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:AYRE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-840-4833
Mailing Address - Street 1:6973 S 4800 W
Mailing Address - Street 2:SUITE C
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84084-7927
Mailing Address - Country:US
Mailing Address - Phone:801-840-4833
Mailing Address - Fax:801-969-2628
Practice Address - Street 1:6973 S 4800 W
Practice Address - Street 2:SUITE C
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84084-7927
Practice Address - Country:US
Practice Address - Phone:801-840-4833
Practice Address - Fax:801-969-2628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-08
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3743501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT519024150002Medicaid