Healthcare Provider Details

I. General information

NPI: 1184834202
Provider Name (Legal Business Name): WESTSIDE ORTHODONTICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 W END AVE SUITE 1 F
NEW YORK NY
10023-4902
US

IV. Provider business mailing address

180 W END AVE SUITE 1 F
NEW YORK NY
10023-4902
US

V. Phone/Fax

Practice location:
  • Phone: 212-595-1500
  • Fax:
Mailing address:
  • Phone: 212-595-1500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number051936
License Number StateNY

VIII. Authorized Official

Name: DR. MICHAEL AYOUB
Title or Position: ORTHODONTIST
Credential: DDS
Phone: 212-595-1500