Individual
WISSAM AYOUB
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
18800 MAIN ST STE 203, HUNTINGTON BEACH, CA 92648-1718
(714) 848-2277
Mailing address
18800 MAIN ST STE 203, HUNTINGTON BEACH, CA 92648-1718
(714) 848-2277
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
55496
CA
1223G0001X
General Practice Dentistry
D7079
AZ
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
55496
CA
Other
Enumeration date
02/05/2007
Last updated
09/09/2020
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