Provider Demographics
NPI:1497188585
Name:NASSIF MOURANI, LAURA (DMD, MSD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:NASSIF MOURANI
Suffix:
Gender:F
Credentials:DMD, MSD
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:NASSIF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:214 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:ROCKLAND
Mailing Address - State:MA
Mailing Address - Zip Code:02370-1961
Mailing Address - Country:US
Mailing Address - Phone:781-878-4000
Mailing Address - Fax:
Practice Address - Street 1:214 MARKET ST
Practice Address - Street 2:
Practice Address - City:ROCKLAND
Practice Address - State:MA
Practice Address - Zip Code:02370-1961
Practice Address - Country:US
Practice Address - Phone:781-878-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-13
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18573811223X0400X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No1223G0001XDental ProvidersDentistGeneral Practice