MEDICARE: SALLY AYOOB DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	2022021935	MO

General Provider Information

NPI Number	:	1215500509
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SALLY AYOOB DMD

Provider Business Mailing Address
First Line	:	2300 HWY 94 S OUTER RD
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63303-8301
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2300 HWY 94 S OUTER RD
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63303-8301
Country	:	US
Telephone Number	:	618-606-4650
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/23/2021
Last Update Date	:	06/23/2024

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