Provider Demographics
NPI:1518159706
Name:HUMAYUN, NOMAHN (DDS)
Entity Type:Individual
Prefix:
First Name:NOMAHN
Middle Name:
Last Name:HUMAYUN
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 1:3223 N BROAD ST FL 3
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19140-5007
Mailing Address - Country:US
Mailing Address - Phone:215-707-7541
Mailing Address - Fax:
Practice Address - Street 1:1901 S BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19148-2216
Practice Address - Country:US
Practice Address - Phone:215-383-1422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-13
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02929700122300000X, 1223P0300X
PASDO435481223P0300X
MI29010196901223P0300X
PADS0435481223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentistGroup - Single Specialty