Provider Demographics
NPI:1689368383
Name:AYOUB-AYOUB, AMAL
Entity Type:Individual
Prefix:DR
First Name:AMAL
Middle Name:
Last Name:AYOUB-AYOUB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8526 SALEM LN
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48127-1390
Mailing Address - Country:US
Mailing Address - Phone:313-505-8507
Mailing Address - Fax:
Practice Address - Street 1:8526 SALEM LN
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-1390
Practice Address - Country:US
Practice Address - Phone:313-505-8507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901601760122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist