Provider Demographics
NPI:1285034918
Name:NUREYEV, ARTEM
Entity type:Individual
Prefix:
First Name:ARTEM
Middle Name:
Last Name:NUREYEV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1222 COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75202-4302
Mailing Address - Country:US
Mailing Address - Phone:267-210-5327
Mailing Address - Fax:
Practice Address - Street 1:2947 S BUCKNER BLVD STE 100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75227-6953
Practice Address - Country:US
Practice Address - Phone:214-420-7008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-29
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30406122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist