Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 7172 | LA |
NPI | 1003346958 |
---|---|
Provider Name | Manal Ayoub |
First Address | New Orleans, LA 70119 |
Second Address | New Orleans, LA 70119 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2017 |
Last Update Date | 06/08/2021 |