Provider Demographics
NPI:1730327578
Name:AYALA, JOANNA CRISTINE (DMD)
Entity type:Individual
Prefix:DR
First Name:JOANNA
Middle Name:CRISTINE
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:PO BOX 356
Mailing Address - Street 2:
Mailing Address - City:LYTLE
Mailing Address - State:TX
Mailing Address - Zip Code:78052-0356
Mailing Address - Country:US
Mailing Address - Phone:830-772-5600
Mailing Address - Fax:
Practice Address - Street 1:9902 MCPHERSON RD
Practice Address - Street 2:STE #25
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78045-6545
Practice Address - Country:US
Practice Address - Phone:956-725-3100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-02
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX242551223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX202663502Medicaid