Organization
AYOUB DENTAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WISSAM AYOUB (DENTIST)
(714) 848-2277
Entity
Organization
Contact information
Practice address
18800 MAIN ST, 203, HUNTINGTON BEACH, CA 92648-1707
(714) 848-2277
(714) 842-6519
Mailing address
18800 MAIN ST, 203, HUNTINGTON BEACH, CA 92648-1707
(714) 848-2277
(714) 842-6519
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
—
—
305R00000X
Preferred Provider Organization
Primary
55496
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
16039600047
—
CA
Enumeration date
03/01/2016
Last updated
09/09/2020
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