Provider Demographics
NPI:1487209748
Name:SADDOUQ, NOUR SAMEER I (DDS)
Entity Type:Individual
Prefix:
First Name:NOUR
Middle Name:SAMEER
Last Name:SADDOUQ
Suffix:I
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 1:23 RHODORA TER
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-4721
Mailing Address - Country:US
Mailing Address - Phone:520-425-2029
Mailing Address - Fax:
Practice Address - Street 1:230 MAPLE ST STE 1
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-5140
Practice Address - Country:US
Practice Address - Phone:413-420-2200
Practice Address - Fax:413-533-6375
Is Sole Proprietor?:No
Enumeration Date:2019-08-05
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADL14003122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist