Provider Demographics
NPI:1881701977
Name:NICOLAS ANIS KFOURI, DMD, PA
Entity type:Organization
Organization Name:NICOLAS ANIS KFOURI, DMD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:NOEL
Authorized Official - Last Name:ABERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-239-3977
Mailing Address - Street 1:2963 MANCHESTER RD
Mailing Address - Street 2:UNIT A
Mailing Address - City:MANCHESTER
Mailing Address - State:MD
Mailing Address - Zip Code:21102-1853
Mailing Address - Country:US
Mailing Address - Phone:410-239-3977
Mailing Address - Fax:410-239-9999
Practice Address - Street 1:2963 MANCHESTER RD
Practice Address - Street 2:UNIT A
Practice Address - City:MANCHESTER
Practice Address - State:MD
Practice Address - Zip Code:21102-1853
Practice Address - Country:US
Practice Address - Phone:410-239-3977
Practice Address - Fax:410-239-9999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10454122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty