Provider Demographics
NPI:1932494408
Name:NOURI, JUNG (DMD)
Entity Type:Individual
Prefix:DR
First Name:JUNG
Middle Name:
Last Name:NOURI
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 1:9201 EAGLE RANCH RD NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-6440
Mailing Address - Country:US
Mailing Address - Phone:505-375-2039
Mailing Address - Fax:
Practice Address - Street 1:9201 EAGLE RANCH RD NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-6440
Practice Address - Country:US
Practice Address - Phone:505-375-2039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-13
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD008877122300000X
NMDD3501122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist