Provider Demographics
NPI:1235561788
Name:AYOUB, AMIN (DDS)
Entity Type:Individual
Prefix:
First Name:AMIN
Middle Name:
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 1:338 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07070-1563
Mailing Address - Country:US
Mailing Address - Phone:201-531-8887
Mailing Address - Fax:201-531-2199
Practice Address - Street 1:338 UNION AVE
Practice Address - Street 2:
Practice Address - City:RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07070-1563
Practice Address - Country:US
Practice Address - Phone:201-531-8887
Practice Address - Fax:201-531-2199
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-07
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18295122300000X
NY046546122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist