Healthcare Provider Details

I. General information

NPI: 1922894815
Provider Name (Legal Business Name): GEORGE AL KHOURI RDH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2025
Last Update Date: 04/16/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

269 UNION ST
LYNN MA
01901-1314
US

IV. Provider business mailing address

1876 HEMPSTEAD DR
TROY MI
48083-2633
US

V. Phone/Fax

Practice location:
  • Phone: 947-205-8157
  • Fax:
Mailing address:
  • Phone: 947-205-8157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: