Provider Demographics
NPI:1366510968
Name:NASRY, HOSSAIN (DDS)
Entity type:Individual
Prefix:
First Name:HOSSAIN
Middle Name:
Last Name:NASRY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3821 W COSTCO DR
Mailing Address - Street 2:#103
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741
Mailing Address - Country:US
Mailing Address - Phone:520-575-8144
Mailing Address - Fax:520-575-8191
Practice Address - Street 1:3821 W COSTCO DR
Practice Address - Street 2:#103
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741
Practice Address - Country:US
Practice Address - Phone:520-575-8144
Practice Address - Fax:520-575-8191
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ42821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice