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General NPI Number Information
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NPI Number | 1225498421
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Entity Type | Organization
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Legal Business Name | AYOUB DENTAL CORPORATION
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Dates
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Enumeration Date | 03/01/2016
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Last Update Date | 09/09/2020
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Provider Practice Location Address
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Address Line | 18800 MAIN ST 203
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92648-1707
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Country | US
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Telephone | 714-848-2277
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Fax | 714-842-6519
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Provider Business Mailing Address
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Address Line | 18800 MAIN ST 203
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92648-1707
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Country | US
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Telephone | 714-848-2277
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Fax | 714-842-6519
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Authorized Official
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Title or Position | DENTIST
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Name | DR. WISSAM AYOUB
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Credential |
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Telephone | 714-848-2277
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 55496
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License Number State | CA
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