Provider Demographics
NPI:1619182797
Name:NOOROLLAH, DANIEL N (DMD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:N
Last Name:NOOROLLAH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:DANIEL
Other - Middle Name:N
Other - Last Name:NOOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:41 PARK AVE
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-3400
Mailing Address - Country:US
Mailing Address - Phone:212-779-7743
Mailing Address - Fax:212-779-7780
Practice Address - Street 1:41 PARK AVE
Practice Address - Street 2:SUITE 1C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-3400
Practice Address - Country:US
Practice Address - Phone:212-779-7743
Practice Address - Fax:212-779-7780
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049632122300000X, 1223E0200X, 1223G0001X, 1223P0221X, 1223P0300X, 1223P0700X, 1223S0112X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223E0200XDental ProvidersDentistEndodontics
Not Answered1223G0001XDental ProvidersDentistGeneral Practice
Not Answered1223P0221XDental ProvidersDentistPediatric Dentistry
Not Answered1223P0300XDental ProvidersDentistPeriodontics
Not Answered1223P0700XDental ProvidersDentistProsthodontics
Not Answered1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Not Answered1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics