Provider Demographics
NPI:1093319923
Name:NUR, JALOL (DMD)
Entity Type:Individual
Prefix:DR
First Name:JALOL
Middle Name:
Last Name:NUR
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9921 BUSTLETON AVE APT J11
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-1546
Mailing Address - Country:US
Mailing Address - Phone:215-939-9934
Mailing Address - Fax:
Practice Address - Street 1:130 ALMSHOUSE RD STE 406
Practice Address - Street 2:
Practice Address - City:RICHBORO
Practice Address - State:PA
Practice Address - Zip Code:18954-1130
Practice Address - Country:US
Practice Address - Phone:215-396-9200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-22
Last Update Date:2020-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0429681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice