MEDICARE: MICHAEL NOURBAKHSH D.D.S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DI 19246	NJ

General Provider Information

NPI Number	:	1457374746
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL NOURBAKHSH D.D.S

Provider Business Mailing Address
First Line	:	138 WESTFIELD AVE
Second Line	:	SUITE B
City	:	CLARK
State	:	NJ
Zip	:	07066-2454
Country	:	US
Telephone Number	:	732-669-0800
Fax Number	:

Provider Business Practice Location Address
First Line	:	138 WESTFIELD AVE
Second Line	:	SUITE B
City	:	CLARK
State	:	NJ
Zip	:	07066-2454
Country	:	US
Telephone Number	:	732-669-0800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	07/21/2022

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