Provider Demographics
NPI:1619095726
Name:MASUD, NOUR (DDS)
Entity Type:Individual
Prefix:DR
First Name:NOUR
Middle Name:
Last Name:MASUD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 SCAMRIDGE CURV
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5213
Mailing Address - Country:US
Mailing Address - Phone:860-967-7521
Mailing Address - Fax:
Practice Address - Street 1:1909 PINE AVE
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14301-2309
Practice Address - Country:US
Practice Address - Phone:716-282-4641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051762-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02851774Medicaid