Provider Demographics
NPI:1821600511
Name:NOUR, RAZAN (DDS)
Entity Type:Individual
Prefix:
First Name:RAZAN
Middle Name:
Last Name:NOUR
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 1:10231 JENNY LYNN WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-5968
Mailing Address - Country:US
Mailing Address - Phone:916-904-6236
Mailing Address - Fax:
Practice Address - Street 1:9299 LAGUNA SPRINGS DR STE 100
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-7842
Practice Address - Country:US
Practice Address - Phone:916-478-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-23
Last Update Date:2021-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA105057122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist