Active NPI
Nour Mahmoud
- Dentist
- Detroit, MI
National Provider Identifier
1144944083
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 2901601424
- Practice address
- 21427 Grand River Ave
Detroit, MI 48219-3896 - Phone
- (313) 412-2100
- NPI assigned
- Oct 3, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 2901601424 | MI | Primary |
Addresses
Primary practice location
21427 Grand River Ave
Detroit, MI 48219-3896
Mailing address
22832 S Brookside Dr
Dearborn Heights, MI 48125-2327
Phone (313) 442-2490
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2901601424 | MI | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1664755200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1664841600000",
"number": "1144944083",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "22832 S BROOKSIDE DR",
"city": "DEARBORN HEIGHTS",
"state": "MI",
"postal_code": "481252327",
"telephone_number": "313-442-2490"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "21427 GRAND RIVER AVE",
"city": "DETROIT",
"state": "MI",
"postal_code": "482193896",
"telephone_number": "313-412-2100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAHMOUD",
"first_name": "NOUR",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-10-03",
"last_updated": "2022-10-04",
"certification_date": "2022-10-04",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MI",
"license": "2901601424",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Detroit, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.