Basic Information
| Provider Information | |||||||||
| NPI: | 1093206872 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NOURI | ||||||||
| FirstName: | GHAZALEH | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3326 CLIPSTONE CT | ||||||||
| Address2: | |||||||||
| City: | RIVERSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925035266 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6262357067 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7319 MILLIKEN AVE STE 110 | ||||||||
| Address2: | |||||||||
| City: | RANCHO CUCAMONGA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917306704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9099453650 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/28/2018 | ||||||||
| LastUpdateDate: | 11/03/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | DDS102462 | CA | Y | Dental Providers | Dentist |
No ID Information.