Healthcare Provider Details

I. General information

NPI: 1053891150
Provider Name (Legal Business Name): SUMAYIA ELNUR DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2018
Last Update Date: 08/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4017 N PRINCE ST
CLOVIS NM
88101-9705
US

IV. Provider business mailing address

2050 E ALGONQUIN RD STE 610
SCHAUMBURG IL
60173-4166
US

V. Phone/Fax

Practice location:
  • Phone: 888-988-4066
  • Fax: 847-496-4850
Mailing address:
  • Phone: 888-988-4066
  • Fax: 847-496-4850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDD4973
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: