Provider Demographics
NPI:1386679322
Name:ABUNASRA, NAZEEH JUMA (DMD)
Entity Type:Individual
Prefix:DR
First Name:NAZEEH
Middle Name:JUMA
Last Name:ABUNASRA
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 1:89 CORNERSTONE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06074-2373
Mailing Address - Country:US
Mailing Address - Phone:917-892-5431
Mailing Address - Fax:
Practice Address - Street 1:89 CORNERSTONE DR
Practice Address - Street 2:
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074-2373
Practice Address - Country:US
Practice Address - Phone:917-892-5431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0094961223S0112X
NH35141223S0112X
NY0545111223S0112X
MA213471223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery