Provider Demographics
NPI:1639784473
Name:ALI, NOREEN NASRUDDIN
Entity Type:Individual
Prefix:
First Name:NOREEN
Middle Name:NASRUDDIN
Last Name:ALI
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 1:6511 ASHFIELD PLACE CT
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-5571
Mailing Address - Country:US
Mailing Address - Phone:281-745-1852
Mailing Address - Fax:
Practice Address - Street 1:21208 NORTHWEST FWY STE 115
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-5975
Practice Address - Country:US
Practice Address - Phone:281-890-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-09
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX366391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice