Healthcare Provider Details

I. General information

NPI: 1053920108
Provider Name (Legal Business Name): GHASSAN KHOURY DMD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2020
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 WASHINGTON ST
SOMERVILLE MA
02143-3823
US

IV. Provider business mailing address

402 WASHINGTON ST
SOMERVILLE MA
02143-3823
US

V. Phone/Fax

Practice location:
  • Phone: 617-666-4444
  • Fax:
Mailing address:
  • Phone: 617-666-4444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: GHASSAN KHOURY
Title or Position: OWNER
Credential:
Phone: 617-666-4444