Healthcare Provider Details

I. General information

NPI: 1871347229
Provider Name (Legal Business Name): AYOUB AMJAD SABER AL ALOUSI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2024
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 FAIRGROUNDS DR
VALLEJO CA
94589-2816
US

IV. Provider business mailing address

200 FAIRGROUNDS DR
VALLEJO CA
94589-2816
US

V. Phone/Fax

Practice location:
  • Phone: 707-552-8195
  • Fax:
Mailing address:
  • Phone: 707-552-8195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number110452
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: