Provider Demographics
NPI:1659626463
Name:CHAHWAN, NOUR (DMD)
Entity Type:Individual
Prefix:DR
First Name:NOUR
Middle Name:
Last Name:CHAHWAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 LIBERTY SQUARE MALL
Mailing Address - Street 2:
Mailing Address - City:STONY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:10980-2400
Mailing Address - Country:US
Mailing Address - Phone:845-429-1293
Mailing Address - Fax:
Practice Address - Street 1:17 LIBERTY SQUARE MALL
Practice Address - Street 2:
Practice Address - City:STONY POINT
Practice Address - State:NY
Practice Address - Zip Code:10980-2400
Practice Address - Country:US
Practice Address - Phone:845-429-1293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-17
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY056978122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist