Provider Demographics
NPI:1386860112
Name:NORDENT LLC
Entity Type:Organization
Organization Name:NORDENT LLC
Other - Org Name:ULTRASMILE
Other - Org Type:Other Name
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:FARID
Authorized Official - Middle Name:
Authorized Official - Last Name:EBRAHIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-830-3138
Mailing Address - Street 1:1423 S HIGLEY RD
Mailing Address - Street 2:STE. 123
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-3429
Mailing Address - Country:US
Mailing Address - Phone:480-830-3138
Mailing Address - Fax:480-830-3158
Practice Address - Street 1:1423 S HIGLEY RD
Practice Address - Street 2:STE. 123
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-3429
Practice Address - Country:US
Practice Address - Phone:480-830-3138
Practice Address - Fax:480-830-3158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ48321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty