| Ayoub Dental Corporation | |
|
18800 Main St 203 Huntington Beach CA 92648-1707 | |
| (714) 848-2277 | |
| (714) 842-6519 |
| Full Name | Ayoub Dental Corporation |
|---|---|
| Speciality | Preferred Provider Organization |
| Location | 18800 Main St, Huntington Beach, California |
| Authorized Official Name and Position | Wissam Ayoub (DENTIST) |
| Authorized Official Contact | 7148482277 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ayoub Dental Corporation 18800 Main St 203 Huntington Beach CA 92648-1707 Ph: (714) 848-2277 | Ayoub Dental Corporation 18800 Main St 203 Huntington Beach CA 92648-1707 Ph: (714) 848-2277 |
| NPI Number | 1225498421 |
|---|---|
| Provider Enumeration Date | 03/01/2016 |
| Last Update Date | 09/09/2020 |
| Medicare PECOS PAC ID | 7810323250 |
|---|---|
| Medicare Enrollment ID | O20200204001117 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225498421 | NPI | - | NPPES |
| 16039600047 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Secondary |
| 305R00000X | Preferred Provider Organization | 55496 (California) | Primary |
| Provider Name | Wissam Ayoub |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1053450577 PECOS PAC ID: 8729414164 Enrollment ID: I20200204001230 |
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