Provider Demographics
NPI:1063637700
Name:AYOUB, MARLIZE ATALLAH (DDS)
Entity Type:Individual
Prefix:
First Name:MARLIZE
Middle Name:ATALLAH
Last Name:AYOUB
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MARLIZE
Other - Middle Name:
Other - Last Name:ATALLAH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:8201 NEWMAN AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-7058
Mailing Address - Country:US
Mailing Address - Phone:714-848-0910
Mailing Address - Fax:714-847-3900
Practice Address - Street 1:8201 NEWMAN AVE STE 302
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-7058
Practice Address - Country:US
Practice Address - Phone:714-848-0910
Practice Address - Fax:714-847-3900
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57890122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist