Provider Demographics
NPI:1376095059
Name:MANSOURI, NOOR SAMEER (BDS, MSD, CAGS)
Entity Type:Individual
Prefix:DR
First Name:NOOR
Middle Name:SAMEER
Last Name:MANSOURI
Suffix:
Gender:F
Credentials:BDS, MSD, CAGS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1539 SW LOOP 410
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78227-1659
Mailing Address - Country:US
Mailing Address - Phone:210-675-8000
Mailing Address - Fax:
Practice Address - Street 1:1539 SW LOOP 410
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78227-1659
Practice Address - Country:US
Practice Address - Phone:210-675-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-28
Last Update Date:2022-04-08
Deactivation Date:2017-06-01
Deactivation Code:
Reactivation Date:2022-04-08
Provider Licenses
StateLicense IDTaxonomies
TX381251223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics