Healthcare Provider Details

I. General information

NPI: 1730336512
Provider Name (Legal Business Name): SAM ALKHOURY, DMD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2008
Last Update Date: 08/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 WASHINGTON ST
HOLLISTON MA
01746-1349
US

IV. Provider business mailing address

403 WASHINGTON ST
HOLLISTON MA
01746-1349
US

V. Phone/Fax

Practice location:
  • Phone: 508-429-7800
  • Fax: 508-429-2517
Mailing address:
  • Phone: 508-429-7800
  • Fax: 508-429-2517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberMA20511
License Number StateMA

VIII. Authorized Official

Name: DR. HOUSSAM ALKHOURY
Title or Position: PRESIDENT
Credential: DMD
Phone: 508-429-7800