Provider Demographics
NPI:1881005023
Name:MARLIZE ATALLAH AYOUB DDS INC.
Entity Type:Organization
Organization Name:MARLIZE ATALLAH AYOUB DDS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/ OFFICE MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARLIZE
Authorized Official - Middle Name:
Authorized Official - Last Name:AYOUB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-848-0910
Mailing Address - Street 1:8201 NEWMAN AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-7058
Mailing Address - Country:US
Mailing Address - Phone:714-848-0910
Mailing Address - Fax:
Practice Address - Street 1:8201 NEWMAN AVE STE 302
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-7058
Practice Address - Country:US
Practice Address - Phone:714-848-0910
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-09
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57890261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA14073600034OtherPENDING MEDICAID