Provider Demographics
NPI:1205814845
Name:KFOURI, NICOLAS ANIS (DMD)
Entity Type:Individual
Prefix:DR
First Name:NICOLAS
Middle Name:ANIS
Last Name:KFOURI
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 1:2963 MANCHESTER RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MANCHESTER
Mailing Address - State:MD
Mailing Address - Zip Code:21102-1853
Mailing Address - Country:US
Mailing Address - Phone:410-239-3977
Mailing Address - Fax:410-239-9999
Practice Address - Street 1:2963 MANCHESTER RD
Practice Address - Street 2:SUITE A
Practice Address - City:MANCHESTER
Practice Address - State:MD
Practice Address - Zip Code:21102-1853
Practice Address - Country:US
Practice Address - Phone:410-239-3977
Practice Address - Fax:410-239-9999
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD104541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice