Provider Demographics
NPI:1578664819
Name:HADI NOUREDINE
Entity Type:Organization
Organization Name:HADI NOUREDINE
Other - Org Name:TODAY'S DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:KATI
Authorized Official - Last Name:MARECEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-644-1110
Mailing Address - Street 1:570 SE BASELINE ST
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-4114
Mailing Address - Country:US
Mailing Address - Phone:503-844-0777
Mailing Address - Fax:503-648-9603
Practice Address - Street 1:570 SE BASELINE ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4114
Practice Address - Country:US
Practice Address - Phone:503-844-0777
Practice Address - Fax:503-648-9603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD86871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR278353Medicaid
OR028155OtherOFFICE OF MEDICAL ASS