MEDICARE: NOUR N MASUD DDS,PLLC

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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1740796309
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOUR N MASUD DDS,PLLC

Provider Business Mailing Address
First Line	:	176 SCAMRIDGE CURV
Second Line	:
City	:	AMHERST
State	:	NY
Zip	:	14221-5213
Country	:	US
Telephone Number	:	860-967-7521
Fax Number	:

Provider Business Practice Location Address
First Line	:	1719 SHERIDAN DR
Second Line	:
City	:	TONAWANDA
State	:	NY
Zip	:	14223-1209
Country	:	US
Telephone Number	:	716-424-0025
Fax Number	:	716-424-0025

Authorized Official
Title or Position	:	GENERAL DENTIST, OWNER
Name	:	DR. NOUR N MASUD
Credential	:	DDS
Telephone Number	:	716-424-0025

Provider Enumeration Date	:	12/19/2017
Last Update Date	:	06/16/2018

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