Provider Demographics
NPI:1144944083
Name:MAHMOUD, NOUR
Entity type:Individual
Prefix:
First Name:NOUR
Middle Name:
Last Name:MAHMOUD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22832 S BROOKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48125-2327
Mailing Address - Country:US
Mailing Address - Phone:313-442-2490
Mailing Address - Fax:
Practice Address - Street 1:21427 GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48219-3896
Practice Address - Country:US
Practice Address - Phone:313-412-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-03
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901601424122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist