Individual provider Active NPI

Mikayla Christine Ayala, DMD

  • Dentist
  • Lebanon, OR
National Provider Identifier
1306493259
Registry record updated Aug 23, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
D11135 Issued in OR
Practice address
816 S 2ND St
Lebanon, OR 97355-3226
Phone
(541) 405-7112
NPI assigned
Aug 23, 2019
Last updated
Aug 23, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X D11135 OR Primary

Addresses

Primary practice location

816 S 2ND St
Lebanon, OR 97355-3226

Mailing address

PO Box 11470
Eugene, OR 97440-3670
Phone (888) 468-0022

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191105000557 OR Order and Referring Only - DentistPractitioner - Dentist 8921330309

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
D11135ORMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Advantage Dental Group, PC PastSince Aug 25, 2019 Accepting new patients
Advantage Dental Group, PC PastSince Aug 25, 2019 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1566518400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566518400000",
    "number": "1306493259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11470",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974403670",
            "telephone_number": "888-468-0022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "816 S 2ND ST",
            "city": "LEBANON",
            "state": "OR",
            "postal_code": "973553226",
            "telephone_number": "541-405-7112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AYALA",
        "first_name": "MIKAYLA",
        "middle_name": "CHRISTINE",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-08-23",
        "last_updated": "2019-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OR",
            "license": "D11135",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lebanon, OR

Sources for this page

Verify at the official NPI Registry.