Individual
DR. IRENE NOSRATI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
342 RANDALL RD, SOUTH ELGIN, IL 60177-2261
(317) 507-9033
Mailing address
5175 PEARLMAN WAY, SAN DIEGO, CA 92130-3715
(317) 507-9033
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019028774
IL
1223G0001X
General Practice Dentistry
12011618A
IN
1223G0001X
General Practice Dentistry
65156
CA
Other
Enumeration date
09/06/2011
Last updated
03/12/2018
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