Provider Demographics
NPI:1427719244
Name:NOURI FAMILY DENTISTRY, LLC
Entity type:Organization
Organization Name:NOURI FAMILY DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:NOURI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-296-3351
Mailing Address - Street 1:7704 FLORENCE AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87122-3769
Mailing Address - Country:US
Mailing Address - Phone:480-296-3351
Mailing Address - Fax:
Practice Address - Street 1:6400 CENTRAL AVE SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87105-2033
Practice Address - Country:US
Practice Address - Phone:480-296-3351
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-04
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM09756736Medicaid