Healthcare Provider Details

I. General information

NPI: 1366372724
Provider Name (Legal Business Name): NOOR TAMIM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 COOPER FOSTER PARK RD
AMHERST OH
44001-1001
US

IV. Provider business mailing address

2860 WATERFALL WAY
WESTLAKE OH
44145-6847
US

V. Phone/Fax

Practice location:
  • Phone: 419-901-0488
  • Fax:
Mailing address:
  • Phone: 440-328-6160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30.028466
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: