Provider Demographics
NPI:1508011123
Name:ALEXANDRA AYOUB, DDS., A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:ALEXANDRA AYOUB, DDS., A PROFESSIONAL CORPORATION
Other - Org Name:FONTANA DENTAL CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:AYOUB
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-829-9324
Mailing Address - Street 1:8110 MANGO AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-3603
Mailing Address - Country:US
Mailing Address - Phone:909-829-9324
Mailing Address - Fax:909-829-9324
Practice Address - Street 1:8110 MANGO AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-3603
Practice Address - Country:US
Practice Address - Phone:909-829-9324
Practice Address - Fax:909-829-9324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-24
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA505641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty