Provider Demographics
NPI:1417309402
Name:MAHJOUB, NOOR (DDS)
Entity Type:Individual
Prefix:
First Name:NOOR
Middle Name:
Last Name:MAHJOUB
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3496 HERON RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-4520
Mailing Address - Country:US
Mailing Address - Phone:248-340-9469
Mailing Address - Fax:
Practice Address - Street 1:30021 GREENFIELD RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-1524
Practice Address - Country:US
Practice Address - Phone:248-971-1920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-01
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901021991122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist