Provider Demographics
NPI:1679303770
Name:AUDI, NOUR (DDS)
Entity type:Individual
Prefix:
First Name:NOUR
Middle Name:
Last Name:AUDI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 HAZEL ST
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011-3409
Mailing Address - Country:US
Mailing Address - Phone:860-944-0161
Mailing Address - Fax:
Practice Address - Street 1:76 HAZEL ST
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-3409
Practice Address - Country:US
Practice Address - Phone:860-944-0161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI03053000122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist