Provider Demographics
NPI:1518598002
Name:AFFORDABLE DENTURES - FOREST PARK, NOUREDDIN KHAZAM, DDS, INC.
Entity Type:Organization
Organization Name:AFFORDABLE DENTURES - FOREST PARK, NOUREDDIN KHAZAM, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NOUREDDIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAZAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:513-648-9479
Mailing Address - Street 1:1173 SMILEY AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45240-1832
Mailing Address - Country:US
Mailing Address - Phone:513-648-9479
Mailing Address - Fax:
Practice Address - Street 1:1173 SMILEY AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45240-1832
Practice Address - Country:US
Practice Address - Phone:513-648-9479
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-03
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty