Provider Demographics
NPI:1730569450
Name:AYOKI-OTIENO, EMILY BERYL (DDS)
Entity type:Individual
Prefix:DR
First Name:EMILY
Middle Name:BERYL
Last Name:AYOKI-OTIENO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:BERYL
Other - Middle Name:EMILY
Other - Last Name:AYOKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:940 RUBY CIR
Mailing Address - Street 2:
Mailing Address - City:GILBERTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19525-8414
Mailing Address - Country:US
Mailing Address - Phone:484-274-7394
Mailing Address - Fax:
Practice Address - Street 1:940 RUBY CIR
Practice Address - Street 2:
Practice Address - City:GILBERTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19525-8414
Practice Address - Country:US
Practice Address - Phone:484-274-7394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-08
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390200000X
PADS040723122300000X
IADDS09363122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program