Provider Demographics
NPI:1770354656
Name:TADRS, NORMAN NASR MASOUD
Entity type:Individual
Prefix:
First Name:NORMAN
Middle Name:NASR MASOUD
Last Name:TADRS
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 1:1171 CRESTON RD STE AND108
Mailing Address - Street 2:
Mailing Address - City:PASO ROBLES
Mailing Address - State:CA
Mailing Address - Zip Code:93446-3031
Mailing Address - Country:US
Mailing Address - Phone:805-434-6740
Mailing Address - Fax:
Practice Address - Street 1:1171 CRESTON RD STE AND108
Practice Address - Street 2:
Practice Address - City:PASO ROBLES
Practice Address - State:CA
Practice Address - Zip Code:93446-3031
Practice Address - Country:US
Practice Address - Phone:805-434-6740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-10
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA109772122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist