Provider Demographics
NPI:1992762694
Name:AYRE, JOHN RANDOLPH (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:RANDOLPH
Last Name:AYRE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 PLEASANT BEND DR
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77382-1297
Mailing Address - Country:US
Mailing Address - Phone:936-217-5300
Mailing Address - Fax:
Practice Address - Street 1:42 PLEASANT BEND DR
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77382-1297
Practice Address - Country:US
Practice Address - Phone:936-217-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLL6061223G0001X
UT374350-99231223G0001X
TX292951223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD119591300Medicaid