Provider Demographics
NPI:1023852258
Name:POL NURIS, MAURITANIA (DMD)
Entity type:Individual
Prefix:
First Name:MAURITANIA
Middle Name:
Last Name:POL NURIS
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 1:1010 NW 100TH AVE
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-4374
Mailing Address - Country:US
Mailing Address - Phone:585-615-3453
Mailing Address - Fax:
Practice Address - Street 1:9818 PINES BLVD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-6141
Practice Address - Country:US
Practice Address - Phone:954-432-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-21
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL29119122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist