Provider Demographics
NPI:1417402579
Name:OUHAME, NISRINE (DDS)
Entity Type:Individual
Prefix:
First Name:NISRINE
Middle Name:
Last Name:OUHAME
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 1:45 MEADOWLANDS PKWY UNIT 301
Mailing Address - Street 2:
Mailing Address - City:SECAUCUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07094-2971
Mailing Address - Country:US
Mailing Address - Phone:973-689-5687
Mailing Address - Fax:
Practice Address - Street 1:45 MEADOWLANDS PKWY UNIT 301
Practice Address - Street 2:
Practice Address - City:SECAUCUS
Practice Address - State:NJ
Practice Address - Zip Code:07094-2971
Practice Address - Country:US
Practice Address - Phone:973-689-5687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-18
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI026447001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ270804390Medicaid