Provider Demographics
NPI:1427227446
Name:M.N AYYUBI,DDS,PA
Entity Type:Organization
Organization Name:M.N AYYUBI,DDS,PA
Other - Org Name:SMILE CITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MUHAMMAD
Authorized Official - Middle Name:NAVEED
Authorized Official - Last Name:AYYUBI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:320-252-0414
Mailing Address - Street 1:1011 2ND ST N
Mailing Address - Street 2:SUITE#201
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-4616
Mailing Address - Country:US
Mailing Address - Phone:320-252-0414
Mailing Address - Fax:320-252-0420
Practice Address - Street 1:1011 2ND ST N
Practice Address - Street 2:SUITE#201
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-4616
Practice Address - Country:US
Practice Address - Phone:320-252-0414
Practice Address - Fax:320-252-0420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-24
Last Update Date:2008-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND12302261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental