Provider Demographics
NPI:1134232804
Name:NOURAI, MARJAN (DDS)
Entity type:Individual
Prefix:
First Name:MARJAN
Middle Name:
Last Name:NOURAI
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 1:25095 JEFFERSON AVENUE
Mailing Address - Street 2:#103
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-9120
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25095 JEFFERSON AVENUE
Practice Address - Street 2:#103
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-9107
Practice Address - Country:US
Practice Address - Phone:951-677-9604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA428651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice