Provider Demographics
NPI:1457834723
Name:NOUNA, RIYAD Y (DDS)
Entity Type:Individual
Prefix:DR
First Name:RIYAD
Middle Name:Y
Last Name:NOUNA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 SPINNING WHEEL RD APT 4K
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-7647
Mailing Address - Country:US
Mailing Address - Phone:269-350-1995
Mailing Address - Fax:
Practice Address - Street 1:120 E LAKE ST
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:IL
Practice Address - Zip Code:60101-2821
Practice Address - Country:US
Practice Address - Phone:630-833-8888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-12
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN237371223G0001X
IL0319291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice