Provider Demographics
NPI:1770139768
Name:AOUTHMANY, NESREEN
Entity type:Individual
Prefix:
First Name:NESREEN
Middle Name:
Last Name:AOUTHMANY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8157 WENONAH CT
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-1091
Mailing Address - Country:US
Mailing Address - Phone:419-882-4170
Mailing Address - Fax:
Practice Address - Street 1:101 ADRIAN ST
Practice Address - Street 2:
Practice Address - City:DELTA
Practice Address - State:OH
Practice Address - Zip Code:43515-1117
Practice Address - Country:US
Practice Address - Phone:855-222-3268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-14
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.025862122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty