Provider Demographics
NPI:1578349114
Name:ASSALEH, NOUR KHALED
Entity Type:Individual
Prefix:DR
First Name:NOUR
Middle Name:KHALED
Last Name:ASSALEH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2949 4TH ST SE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-2913
Mailing Address - Country:US
Mailing Address - Phone:612-703-0131
Mailing Address - Fax:
Practice Address - Street 1:2949 4TH ST SE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55414-2913
Practice Address - Country:US
Practice Address - Phone:612-703-0131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR865122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist