Basic Information
| Provider Information | |||||||||
| NPI: | 1861014672 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AYOUTY | ||||||||
| FirstName: | NADINE | ||||||||
| MiddleName: | |||||||||
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| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7625 VIA CAMPANILE STE 130 | ||||||||
| Address2: | |||||||||
| City: | CARLSBAD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920098489 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7606331653 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7625 VIA CAMPANILE STE 130 | ||||||||
| Address2: | |||||||||
| City: | CARLSBAD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920098489 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7606331653 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2020 | ||||||||
| LastUpdateDate: | 09/16/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | RES.004191 | OH | N | Dental Providers | Dentist | General Practice | 1223G0001X | DDS106103 | CA | Y | Dental Providers | Dentist | General Practice |
No ID Information.