Provider Demographics
NPI:1952698474
Name:SHOREIBAH, NOURELDIN HUSSEIN (DDS)
Entity Type:Individual
Prefix:
First Name:NOURELDIN
Middle Name:HUSSEIN
Last Name:SHOREIBAH
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 1:16052 BEACH BLVD STE 112
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-3842
Mailing Address - Country:US
Mailing Address - Phone:415-412-8963
Mailing Address - Fax:
Practice Address - Street 1:16052 BEACH BLVD STE 112
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-3842
Practice Address - Country:US
Practice Address - Phone:415-412-8963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-05
Last Update Date:2017-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA604611223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty