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General NPI Number Information
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NPI Number | 1508011123
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Entity Type | Organization
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Legal Business Name | ALEXANDRA AYOUB, DDS., A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 11/24/2008
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Last Update Date | 11/24/2008
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Provider Practice Location Address
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Address Line | 8110 MANGO AVE SUITE 101
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City | FONTANA
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State | CA
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Zip | 92335-3603
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Country | US
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Telephone | 909-829-9324
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Fax | 909-829-9324
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Provider Business Mailing Address
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Address Line | 8110 MANGO AVE SUITE 101
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City | FONTANA
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State | CA
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Zip | 92335-3603
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Country | US
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Telephone | 909-829-9324
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Fax | 909-829-9324
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ALEXANDRA AYOUB
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Credential | DDS
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Telephone | 909-829-9324
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 50564
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License Number State | CA
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