Provider Demographics
NPI:1992263727
Name:AYALA, MARIEL ANGELIE (DMD)
Entity type:Individual
Prefix:DR
First Name:MARIEL
Middle Name:ANGELIE
Last Name:AYALA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BIMINI 1
Mailing Address - Street 2:PONCE DE LEON
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680
Mailing Address - Country:US
Mailing Address - Phone:787-220-2094
Mailing Address - Fax:
Practice Address - Street 1:101 MENDEZ VIGO W STE 107
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-3800
Practice Address - Country:US
Practice Address - Phone:787-834-5680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-11
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR33711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty