Provider Demographics
NPI:1407940273
Name:BRUCE S. NOURI, ALI R. AGHAEE, PA
Entity Type:Organization
Organization Name:BRUCE S. NOURI, ALI R. AGHAEE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TRESURER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:S
Authorized Official - Last Name:NOURI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-417-6957
Mailing Address - Street 1:15245 SHADY GROVE RD STE 420
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3222
Mailing Address - Country:US
Mailing Address - Phone:301-417-6957
Mailing Address - Fax:301-417-9699
Practice Address - Street 1:15245 SHADY GROVE RD STE 420
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3222
Practice Address - Country:US
Practice Address - Phone:301-417-6957
Practice Address - Fax:301-417-9699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD98441223G0001X
MD98861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty