MEDICARE: NIVIEN MASOUD

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	390200000X	Student in an Organized Health Care Education/Training Program
2	122300000X	Dentist	30.026746	OH

General Provider Information

NPI Number	:	1902472871
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIVIEN MASOUD

Provider Business Mailing Address
First Line	:	31368 BUR OAK DR
Second Line	:
City	:	WESTLAKE
State	:	OH
Zip	:	44145-6869
Country	:	US
Telephone Number	:	708-996-5844
Fax Number	:

Provider Business Practice Location Address
First Line	:	2904 EUCLID AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44115-2416
Country	:	US
Telephone Number	:	216-539-3950
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2021
Last Update Date	:	01/05/2023

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Directions to “ NIVIEN MASOUD ” Practice Location

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