Individual
NIKTA MANSOURI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
310 PREMIER BLVD, ROANOKE RAPIDS, NC 27870-5080
(252) 219-3153
Mailing address
4110 BRIARGROVE CIR UNIT 3-213, RALEIGH, NC 27607-6533
(313) 410-4897
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
D14993
MN
1223G0001X
General Practice Dentistry
Primary
14021
NC
Other
Enumeration date
08/29/2023
Last updated
11/25/2024
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