Provider Demographics
NPI:1912069170
Name:NOURI, SHAHRAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHAHRAM
Middle Name:
Last Name:NOURI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9318 RESEDA BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-2926
Mailing Address - Country:US
Mailing Address - Phone:818-885-5200
Mailing Address - Fax:818-885-0087
Practice Address - Street 1:9318 RESEDA BLVD
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-2926
Practice Address - Country:US
Practice Address - Phone:818-885-5200
Practice Address - Fax:818-885-0087
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA489741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice