Provider Demographics
NPI:1871668137
Name:NASRI-GHAJARI, NOUSHIN (DDS)
Entity Type:Individual
Prefix:
First Name:NOUSHIN
Middle Name:
Last Name:NASRI-GHAJARI
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 1:163 ALPINE DR
Mailing Address - Street 2:
Mailing Address - City:CLOSTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07624-2811
Mailing Address - Country:US
Mailing Address - Phone:201-741-9565
Mailing Address - Fax:201-302-9845
Practice Address - Street 1:2225 LEMOINE AVE.
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024
Practice Address - Country:US
Practice Address - Phone:201-741-9565
Practice Address - Fax:201-302-9845
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ194471223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry