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General NPI Number Information
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NPI Number | 1821600511
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Entity Type | Individual
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Provider Name | RAZAN NOUR DDS
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Gender | Female
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Dates
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Enumeration Date | 08/23/2020
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Last Update Date | 12/12/2021
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Provider Practice Location Address
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Address Line | 9299 LAGUNA SPRINGS DR STE 100
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City | ELK GROVE
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State | CA
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Zip | 95758-7842
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Country | US
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Telephone | 916-478-7200
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Fax |
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Provider Business Mailing Address
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Address Line | 10231 JENNY LYNN WAY
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City | ELK GROVE
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State | CA
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Zip | 95757-5968
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Country | US
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Telephone | 916-904-6236
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 105057
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License Number State | CA
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