Provider Demographics
NPI:1518910066
Name:AYOUB, GEORGE RAYMOND (DDS)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:RAYMOND
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 1:521 W THOMAS RD
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-4240
Mailing Address - Country:US
Mailing Address - Phone:602-307-5775
Mailing Address - Fax:
Practice Address - Street 1:521 W THOMAS RD
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4240
Practice Address - Country:US
Practice Address - Phone:602-307-5775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ63991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ#001696388OtherUCCI
AZ951500OtherAHCCCS