Provider Demographics
NPI:1629245295
Name:AYOUB, HISHAM S (DMD)
Entity Type:Individual
Prefix:DR
First Name:HISHAM
Middle Name:S
Last Name:AYOUB
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 WOODGATE CIR
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33326-2137
Mailing Address - Country:US
Mailing Address - Phone:954-647-8272
Mailing Address - Fax:
Practice Address - Street 1:111 N PINE ISLAND RD
Practice Address - Street 2:STE 101
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-1836
Practice Address - Country:US
Practice Address - Phone:954-473-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN176401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice