Provider Demographics
NPI:1013202076
Name:AYOUB, ELLIOT MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELLIOT
Middle Name:MICHAEL
Last Name:AYOUB
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 E FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701-8212
Mailing Address - Country:US
Mailing Address - Phone:432-687-7068
Mailing Address - Fax:432-687-7096
Practice Address - Street 1:801 E FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-8212
Practice Address - Country:US
Practice Address - Phone:432-687-7068
Practice Address - Fax:432-687-7096
Is Sole Proprietor?:No
Enumeration Date:2011-06-17
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27048122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist