Provider Demographics
NPI:1689969800
Name:NOURI, ALEXANDER (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:
Last Name:NOURI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6830 MONTGOMERY BLVD NE STE A
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-1455
Mailing Address - Country:US
Mailing Address - Phone:480-296-3351
Mailing Address - Fax:
Practice Address - Street 1:6830 MONTGOMERY BLVD NE STE A
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1455
Practice Address - Country:US
Practice Address - Phone:505-830-9081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-15
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY058419122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist