Provider Demographics
NPI:1194205625
Name:REZAPOUR, NOURA
Entity Type:Individual
Prefix:
First Name:NOURA
Middle Name:
Last Name:REZAPOUR
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 1:8960 W POST RD UNIT 2084
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-2458
Mailing Address - Country:US
Mailing Address - Phone:801-386-6038
Mailing Address - Fax:
Practice Address - Street 1:8995 W FLAMINGO RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-0441
Practice Address - Country:US
Practice Address - Phone:725-677-1164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVS6-1851223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry