Individual provider Active NPI

John Randolph Ayre, DDS

  • Pediatric Dentistry
  • The Woodlands, TX
National Provider Identifier
1992762694
Registry record updated Apr 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
29295 Issued in TX
Practice address
42 Pleasant Bend Dr
The Woodlands, TX 77382-1297
Phone
(936) 217-5300
NPI assigned
Apr 27, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X LL606 MD
General Practice Dentistry 1223G0001X 374350-9923 UT
Pediatric Dentistry 1223P0221X 29295 TX Primary

Addresses

Primary practice location

42 Pleasant Bend Dr
The Woodlands, TX 77382-1297

Mailing address

42 Pleasant Bend Dr
The Woodlands, TX 77382-1297
Phone (936) 217-5300

Other practice location 1

12165 Elm St
Princess Anne, MD 21853-1358
Phone (410) 651-5151

Other identifiers 1

IdentifierTypeStateIssuer
119591300MedicaidMD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20150730013249 TX Order and Referring Only - DentistPractitioner - Dentist 9032423355

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LL606MDMDGeneral Practice Dentistry
374350-9923UTMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1146096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681171200000",
    "number": "1992762694",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "42 PLEASANT BEND DR",
            "city": "THE WOODLANDS",
            "state": "TX",
            "postal_code": "773821297",
            "telephone_number": "936-217-5300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "42 PLEASANT BEND DR",
            "city": "THE WOODLANDS",
            "state": "TX",
            "postal_code": "773821297",
            "telephone_number": "936-217-5300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12165 Elm St",
            "address_purpose": "LOCATION",
            "city": "Princess Anne",
            "state": "MD",
            "postal_code": "218531358",
            "country_code": "US",
            "telephone_number": "410-651-5151",
            "fax_number": "410-651-4256",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "AYRE",
        "first_name": "JOHN",
        "middle_name": "RANDOLPH",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-27",
        "last_updated": "2023-04-11",
        "certification_date": "2023-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MD",
            "license": "LL606",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "UT",
            "license": "374350-9923",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "TX",
            "license": "29295",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "119591300",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in The Woodlands, TX

Sources for this page

Verify at the official NPI Registry.