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General NPI Number Information
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NPI Number | 1184834202
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Entity Type | Organization
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Legal Business Name | WESTSIDE ORTHODONTICS PC
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 180 W END AVE SUITE 1 F
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City | NEW YORK
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State | NY
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Zip | 10023-4902
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Country | US
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Telephone | 212-595-1500
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Fax |
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Provider Business Mailing Address
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Address Line | 180 W END AVE SUITE 1 F
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City | NEW YORK
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State | NY
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Zip | 10023-4902
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Country | US
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Telephone | 212-595-1500
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Fax |
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Authorized Official
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Title or Position | ORTHODONTIST
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Name | DR. MICHAEL AYOUB
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Credential | DDS
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Telephone | 212-595-1500
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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 | 051936
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License Number State | NY
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