Provider Demographics
NPI:1356790166
Name:AYON, JOEL (DMD)
Entity type:Individual
Prefix:DR
First Name:JOEL
Middle Name:
Last Name:AYON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6409 FITCHETT ST UNIT 2
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11374-5050
Mailing Address - Country:US
Mailing Address - Phone:480-313-4374
Mailing Address - Fax:
Practice Address - Street 1:23 BOND ST STE 8
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-2025
Practice Address - Country:US
Practice Address - Phone:516-300-1750
Practice Address - Fax:516-482-0401
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-13
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0612681223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty