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General NPI Number Information
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NPI Number | 1164761383
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Entity Type | Organization
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Legal Business Name | WILD WEST ORTHODONTICS INC.
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Dates
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Enumeration Date | 02/07/2013
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Last Update Date | 02/07/2013
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Provider Practice Location Address
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Address Line | 14122 W MCDOWELL RD STE 200
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City | GOODYEAR
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State | AZ
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Zip | 85395-2505
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Country | US
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Telephone | 623-536-2040
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Fax | 623-536-8555
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Provider Business Mailing Address
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Address Line | 14122 W MCDOWELL RD STE 200
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City | GOODYEAR
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State | AZ
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Zip | 85395-2505
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Country | US
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Telephone | 623-536-2040
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Fax | 623-536-8555
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Authorized Official
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Title or Position | OWNER/DOCTOR
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Name | DR. GEORGE AYOUB
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Credential | DDS
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Telephone | 623-536-2040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 0008582
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License Number State | AZ
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