Healthcare Provider Details

I. General information

NPI: 1770139768
Provider Name (Legal Business Name): NESREEN AOUTHMANY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2019
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 W ALEXIS RD
TOLEDO OH
43612
US

IV. Provider business mailing address

8157 WENONAH CT
SYLVANIA OH
43560-1091
US

V. Phone/Fax

Practice location:
  • Phone: 833-378-4827
  • Fax:
Mailing address:
  • Phone: 419-882-4170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30.025862
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: