Healthcare Provider Details

I. General information

NPI: 1770963746
Provider Name (Legal Business Name): AYMAN AL DAYEH BDS, MSD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2015
Last Update Date: 06/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 UNION AVE, S312 DEPARTMENT OF ORTHODONTICS
MEMPHIS TN
38163
US

IV. Provider business mailing address

4047 MAIN COURT
KEFRAYA WEST BEKAA
4047
LB

V. Phone/Fax

Practice location:
  • Phone: 901-448-2168
  • Fax:
Mailing address:
  • Phone: 961-864-5282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number9793
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number28660
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: